Long Term Outcomes   of Restorative Home Care          Gill Lewin, Janine Alan, Helman Alfonso                     IFA May...
Restorative Home Care Programs Aim to maximise independence, self esteem and quality of  life and reduce care required K...
Silver Chain                                                                       WA West Australian Community Health a...
Silver Chain’s Restorative Programs Home Independence Program (HIP)             •            Older individuals needing ho...
Study Objectives Primary objective:          Compare aged care service use over 5 yrs of individuals who          partici...
Study Design and Method Retrospective Cohort Study 65+ yr old HIP, PEP and HACC clients Referred for service 1 Jan 2004...
Results - Demographics                                                             Control    PEP     HIP                 ...
Results – HACC All Service Use          100                                                                               ...
Results – HACC Personal Care Use    100                                                                                   ...
Results – ACAT assessment over timeYear acap                      Control                         PEP               HIP   ...
Results – Risk of death                                                                                 1.5               ...
Results – Adjusted Median Cumulative Costs                                                                                ...
Returns on Investment                                                                                     *Adjusted for ag...
ConclusionsIndividuals who receive a restorative home careservice rather than usual HACC home care: have a reduced likeli...
Contact for more information:                                                       g.lewin@curtin.edu.auRestorative Home ...
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2 lewin-ifa restorative care outcomes

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2 lewin-ifa restorative care outcomes

  1. 1. Long Term Outcomes of Restorative Home Care Gill Lewin, Janine Alan, Helman Alfonso IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  2. 2. Restorative Home Care Programs Aim to maximise independence, self esteem and quality of life and reduce care required Key elements: • Comprehensive assessment • Goal setting • Individualised care plans • Targeted evidence-based interventions• Often time limited• May be directed to specific target groupsRestorative Home Care Long Term Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  3. 3. Silver Chain WA West Australian Community Health and Aged Care Provider 40,000 + clients annually Many health and home support services ~ 45% of Govt. funded home care in WA In 1999 had waitlists for home care services Developed Restorative Home Care programs, HIP + PEP HIP + PEP available across Perth since 2002Restorative Home Care Long Term Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  4. 4. Silver Chain’s Restorative Programs Home Independence Program (HIP) • Older individuals needing homecare • Community based referral • 12 weeks maximum Personal Enablement Program (PEP) • Leaving hospital, potential to improve • Hospital referral (may include post acute nursing) • 8 weeks maximumRestorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  5. 5. Study Objectives Primary objective: Compare aged care service use over 5 yrs of individuals who participated in HIP / PEP with that of individuals who received HACC. Secondary objectives: Examine the impact of participating in an independence program, as compared to receiving usual home care services, on delaying the need for recommendation into residential care, improving survival and reducing care costs over time.Restorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  6. 6. Study Design and Method Retrospective Cohort Study 65+ yr old HIP, PEP and HACC clients Referred for service 1 Jan 2004 – 31 Dec 2008 No diagnosis of dementia 2004-2009 client data from Silver Chain Comcare, HACC MDS, ACAP database and mortality register linked Service use examined at 12, 24,36, 48 and 60 months Poisson regression to identify predictors of service use Cox regression to compare ACAT assessment or death Quantile regression to compare costs between groupsRestorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  7. 7. Results - Demographics Control PEP HIP N=2,332 5,450 2,586 Older than 78y 71.6% 49.3% 59.8% Females 63.4 74.3 78.3 Need carer 26.8 64.6 57.7 Living with others 39.6 60.3 58.5 Previous HAAC 58.1 44.6 48.0 Dependence low 25.5 22.2 19.3 Dependence mod 34.9 44.1 42.7 Dependence high 35.4 6.1 9.6 0 1 2 3 4 5 6 7 8 9 10 11 120.00 0.50 1.00 1.50 2.00 TITLE Prevalence RatioRestorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  8. 8. Results – HACC All Service Use 100 Control PEP HIP 80 *Adjusted for age, sex, living arrangement, having carer, dependence 60 level and requiring PC service previous start study 40 20 0 12 24 36 48 60 Months of follow up Control, n(%) 2002 (90.9) 1068 (65.8) 518 (50.2) 244 (39.2) 111 (33.0) 26 (34.2) PEP, n(%) 3813 (71.8) 2031 (44.3) 1323 (40.8) 782 (38.5) 382 (37.8) 127 (41.5) HIP, n(%) 1878 (75.2) 1068 (48.2) 694 (42.8) 428 (40.8) 224 (41.0) 70 (46.7)Restorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  9. 9. Results – HACC Personal Care Use 100 Control PEP HIP 80 *Adjusted for age, sex, living arrangement, having carer, 60 dependence level and requiring PC service previous start study 40 20 0 0 12 24 36 48 60 Months of follow up Control, n(%) 1886 (85.6) 877 (54.0) 403 (39.1) 183 (29.4) 81 (24.1) 19 (25.0) PEP, n(%) 1300 (24.5) 336 (7.3) 189 (5.8) 129 (6.4) 58 (5.7) 10 (3.3) HIP, n(%) 825 (33.0) 224 (10.1) 131 (8.1) 68 (6.5) 34 (6.2) 3 (2.0)Restorative Home Care Outcomes 26.10.2011Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  10. 10. Results – ACAT assessment over timeYear acap Control PEP HIP outcome level Control PEP HIP N=2,332 N=5,450 N=2,586 N=2,332 N=5,450 N=2,5862004 14 (0.60) 10 (0.18) 7 (0.27) appcomm 12005 91 (3.90) 176 (3.23) 87 (3.36) 24 (1.03) 27 (0.50) 12 (0.46) appeach 12006 27 (1.16) 22 (0.40) 13 (0.50) 30 (1.29) 54 (0.99) 22 (0.85) appother 12007 99 (4.25) 204 (3.74) 94 (3.63) 35 (1.50) 78 (1.43) 42 (1.62) appresi 12008 31 (1.33) 68 (1.25) 24 (0.93) 86 (3.69) 160 (2.94) 75 (2.90)2009 appresi 2 13 (0.56) 19 (0.35) 18 (0.70)Total 147 (6.30) 256 (4.70) 125 (4.83) 29 (1.24) 20 (0.37) 13 (0.50) group Crude OR Adjusted* OR (95% CI) (95% CI) *Adjusted for age, sex, living arrangement, having carer, dependence level and requiring PC service previous start study , using Cox regression PEP 0.64 (0.52-0.79) 0.96 (0.75-1.22) HIP 0.65 (0.51-0.82) 0.91 (0.69-1.19) Restorative Home Care Outcomes IFA May 2012 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
  11. 11. Results – Risk of death 1.5 Control PEP HIP group Crude OR Adjusted* OR Cumulative Mortality Rate (95% CI) (95% CI) 1 PEP 0.39 (0.36-0.42) 0.52 (0.47-0.57) HIP 0.45 (0.41-0.50) 0.58 (0.52-0.65) .5*Adjusted for age, sex, living arrangement,having carer, dependence level andrequiring PC service previous start study ,using Cox regression 0 0 2 4 6 Years of follow upRestorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  12. 12. Results – Adjusted Median Cumulative Costs *Adjusted for age, sex, living arrangement, having carer, dependence level and requiring PC service previous start studyRestorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  13. 13. Returns on Investment *Adjusted for age, sex, living arrangement, having carer, dependence level and requiring PC service previous start studyRestorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  14. 14. ConclusionsIndividuals who receive a restorative home careservice rather than usual HACC home care: have a reduced likelihood of subsequently using: - any home care service for three years - a personal care service for five years are somewhat less likely to be ACAT assessed within the next 5 years and much less likely to be approved for nursing home high level care are less likely to die over the next 5 years represent a much better return on investmentRestorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
  15. 15. Contact for more information: g.lewin@curtin.edu.auRestorative Home Care Outcomes IFA May 2012Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
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