2 lewin-ifa restorative care outcomes

Curtin University is a trademark of Curtin University of Technology

CRICOS Provider Code 00301J

Gill Lewin, Janine Alan, Helman Alfonso

Long Term Outcomes

of Restorative Home Care IFA May 2012



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 groups

IFA May 2012 Restorative Home Care Long Term Outcomes



Silver Chain

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 2002

IFA May 2012 Restorative Home Care Long Term Outcomes

WA



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 maximum

IFA May 2012 Restorative Home Care Outcomes



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.




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 groups




Results - Demographics


35.4

34.9

25.5

58.1

39.6

26.8

63.4

71.6%

N=2,332

6.1

44.1

22.2

44.6

60.3

64.6

74.3

49.3%

5,450

9.6

42.7

19.3

48.0

58.5

57.7

78.3

59.8%

2,586

Control PEP HIP

Dependence high

Dependence mod

Dependence low

Previous HAAC

Living with others

Need carer

Females

Older than 78y

0 1 2 3 4 5 6 7 8 9 10 11 12TITLE

0.00 0.50 1.00 1.50 2.00Prevalence Ratio



Results – HACC All Service Use


2040

6080

100

% r

equi

ring

serv

ices

0 12 24 36 48 60Months of follow up

Control PEP

HIP

2002 (90.9) 1068 (65.8) 518 (50.2) 244 (39.2) 111 (33.0) 26 (34.2)Control, n(%)

3813 (71.8) 2031 (44.3) 1323 (40.8) 782 (38.5) 382 (37.8) 127 (41.5)PEP, n(%)

1878 (75.2) 1068 (48.2) 694 (42.8) 428 (40.8) 224 (41.0) 70 (46.7)HIP, n(%)

*Adjusted for age,

sex, living

arrangement, having

carer, dependence

level and requiring

PC service previous

start study



Results – HACC Personal Care Use

26.10.2011 Restorative Home Care Outcomes

020

4060

8010

0

% r

equi

ring

serv

ices

0 12 24 36 48 60Months of follow up

Control PEP

HIP

1886 (85.6) 877 (54.0) 403 (39.1) 183 (29.4) 81 (24.1) 19 (25.0)Control, n(%)

1300 (24.5) 336 (7.3) 189 (5.8) 129 (6.4) 58 (5.7) 10 (3.3)PEP, n(%)

825 (33.0) 224 (10.1) 131 (8.1) 68 (6.5) 34 (6.2) 3 (2.0)HIP, n(%)

*Adjusted for age, sex,

living arrangement,

having carer,

dependence level and

requiring PC service

previous start study



Results – ACAT assessment over time


Year acap Control

N=2,332

PEP

N=5,450

HIP

N=2,586

2004 14 (0.60) 10 (0.18) 7 (0.27)

2005

24 (1.03) 27 (0.50) 12 (0.46)

2006 30 (1.29) 54 (0.99) 22 (0.85)

2007 35 (1.50) 78 (1.43) 42 (1.62)

2008 31 (1.33) 68 (1.25) 24 (0.93)

2009 13 (0.56) 19 (0.35) 18 (0.70)

Total 147 (6.30) 256 (4.70) 125 (4.83)

outcome level Control

N=2,332

PEP

N=5,450

HIP

N=2,586

appcomm 1

91 (3.90) 176 (3.23) 87 (3.36)

appeach 1

27 (1.16) 22 (0.40) 13 (0.50)

appother 1

99 (4.25) 204 (3.74) 94 (3.63)

appresi 1

86 (3.69) 160 (2.94) 75 (2.90)

appresi 2

29 (1.24) 20 (0.37) 13 (0.50)

group Crude OR

(95% CI)

Adjusted* OR (95% CI)

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)

*Adjusted for age, sex, living arrangement, having

carer, dependence level and requiring PC service

previous start study , using Cox regression



Results – Risk of death


0.5

11

.5

Cum

ula

tive M

ort

ality

Rate

0 2 4 6Years of follow up

Control PEP

HIP

group Crude OR

(95% CI)

Adjusted* OR

(95% CI)

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)

*Adjusted for age, sex, living arrangement,

having carer, dependence level and

requiring PC service previous start study ,

using Cox regression



Results – Adjusted Median Cumulative Costs


*Adjusted for age, sex,

living arrangement,

having carer,

dependence level and

requiring PC service

previous start study



Returns on Investment


*Adjusted for age,

sex, living

arrangement, having

carer, dependence

level and requiring PC

service previous start

study



Conclusions

Individuals who receive a restorative home care

service 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 investment




Contact for more information:

[email protected]


2 lewin-ifa restorative care outcomes

Health & Medicine