Prolonged Wait Time Prior to Entry to Home Care Packages Increases the Risk of Mortality and Transition to Permanent Residential Aged Care Services: Findings from the Registry of Older South Australians (ROSA)

Abstract

Background Older Australians prefer to live in their own homes for longer and reforms have attempted to increase the volume of home care packages (HCPs) accordingly but there remains a queue with the longer-term consequences unclear. Objectives This study aims to characterise older Australians according to their wait times for a home care package (HCP), evaluate the association between wait time and mortality and evaluate the association between wait time and transition to permanent residential aged care services after HCP. Design A retrospective cohort study using data from the National Historical cohort (2003-2014) of the Registry of Older South Australians (ROSA) was conducted. Setting Home based aged care services, national cohort. Methods Wait time was estimated from approval date to date of receiving a HCP. Descriptive, survival estimates (95% confidence intervals (CIs)), and multivariable survival analyses (Cox-regression) were conducted to evaluate the risk of mortality and transition to permanent residential aged care services by quartiles of wait time for HCP. Results The cohort was followed for 4.0 years (interquartile range IQR (1.8-7.2)) and 38% were alive at the end of the study period with a median wait time for HCP of 62 (21-187) days. From 178,924 older people who received a HCP during the study period (2003-2013), 33.2% people received HCP within 30 days, 74.3% within 6 months and 25.7% after 6 months. The effect of wait time on risk of mortality was time-dependent, with longer wait times associated with higher mortality in the longer term. Compared to people who waited ≤30 days for a HCP, individuals who waited more than 6 months had an almost 20% excess risk of death (adjusted hazard ratio (aHR), 95%CI = (1.18, 1.16-1.21)) 2 years after entry into a HCP. Those who waited more than 6 months also had a 10% (1.10, 1.06-1.13) higher risk of transition to permanent residential aged care services after two years. Conclusion Prolonged wait times for HCP is associated with a higher risk of long-term mortality as well as transition to permanent residential aged care. It remains to be seen if a shortening of this wait time translates into better health outcomes. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-018-1145-y and is accessible for authorized users.

The Frailty In Residential Sector over Time (FIRST) study: methods and baseline cohort description

“…Australia when compared to the Organisation for Economic Co-operation and Development (OECD) average of 42.8 places per 1000 population aged 65 years and over remains well placed with 51 residential aged care places per 1000 population aged 65 years and over [ 39 ]. Supporting a need to shift towards community aged care services, we have previously reported that older people continue to wait for long periods for home care packages and this is associated with increased risk of mortality and placement into RACS [ 40 ]. Frailty levels in this population are likely to be higher given that we excluded from our study residents who were medically unstable ( n = 22, 1.8%) or receiving palliative care (n = 22, 1.8%).…”

The prevalence, trends and determinants of mental health disorders in older Australians living in permanent residential aged care: Implications for policy and quality of aged care services

“…A retrospective cross-sectional study using data from the National Historical Cohort of the Registry of Senior Australians (ROSA) (Harrison et al, 2019; Inacio et al, 2019; Visvanathan et al, 2019) between 1 July 2008 and 30 June 2016 was conducted. ROSA is comprised of linked de-identified national data from the AIHW’s National Aged Care Data Clearinghouse, the Pharmaceutical Benefits Scheme (PBS) and the Medicare Benefits Schedule (MBS) datasets (Inacio et al, 2019).…”

“…This study has implications for future mental health research in the aged care sector by highlighting variations of disease prevalence across the different aged care services. For instance, the prevalence of depression in those receiving community care packages is 16% (Visvanathan et al, 2019); however, this estimate is tripled in individuals living in residential aged care. Thus, in the future, it is important to identify the critical period of change in disease prevalence and provide the right health interventions while older people are transiting across the different pathways in the aged care spectrum.…”

Factors associated with accessing aged care services in Australia after approval for services: Findings from the historical cohort of the Registry of Senior Australians

“…The less frequent access of respite approvals could reflect the reported attitudes and concerns of older people about accessing these services . Finally, although not examined here, the lower access of home care services could be influenced by difficulties in accessing services (eg limited availability) …”