Original Study| Volume 19, ISSUE 2, P117-121.e3, February 2018

Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data

Published:September 23, 2017DOI:



      To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care.


      Longitudinal cohort study using routinely collected client management data.


      A large aged care service provider in New South Wales and the Australian Capital Territory, Australia.


      A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016.


      Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used.


      By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer.


      Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults’ care choices.


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        • Commonwealth Treasury
        Australia to 2050: Future challenges.
        (Commonwealth of Australia, Capital Hill, ACT. Available at:) (Accessed September 8, 2017)
        • Wübker A.
        • Zwakhalen S.M.
        • Challis D.
        • et al.
        Costs of care for people with dementia just before and after nursing home placement: Primary data from eight European countries.
        Eur J Health Econ. 2015; 16: 689-707
        • Australian Institute of Health and Welfare
        The desire to age in place among older Australians. AIHW bulletin no. 114. Cat. no. AUS 169.
        AIHW, Canberra2013 (Available at:) (Accessed May 17, 2017)
        • Brownie S.
        • Nancarrow S.
        Effects of person-centered care on residents and staff in aged-care facilities: A systematic review.
        Clin Intervent Aging. 2013; 8: 1-10
      1. Aged Care (Living Longer Living Better) Bill 2013 (Cth).

        • Gill L.
        • McCaffrey N.
        • Cameron I.D.
        • et al.
        Consumer directed care in Australia: Early perceptions and experiences of staff, clients and carers.
        Health Soc Care Community. 2017; 25: 478-491
        • Rodrigues R.
        • Glendinning C.
        Choice, competition and care–Developments in English social care and the impacts on providers and older users of home care services.
        Soc Policy Adm. 2015; 49: 649-664
        • Gaugler J.E.
        • Duval S.
        • Anderson K.A.
        • Kane R.L.
        Predicting nursing home admission in the US: A meta-analysis.
        BMC Geriatr. 2007; 7: 13
        • Sarma S.
        • Hawley G.
        • Basu K.
        Transitions in living arrangements of Canadian seniors: Findings from the NPHS longitudinal data.
        Social Sci Med. 2009; 68: 1106-1113
        • Sands L.P.
        • Xu H.
        • Thomas III, J.
        • et al.
        Volume of home-and community-based services and time to nursing-home placement.
        Medicare Medicaid Res Rev. 2011; 2: E1-E21
        • Chen Y.M.
        • Berkowitz B.
        Older adults' home-and community-based care service use and residential transitions: A longitudinal study.
        BMC Geriatr. 2012; 12: 44
        • Greiner M.A.
        • Qualls L.G.
        • Iwata I.
        • et al.
        Predicting nursing home placement among home-and community-based services program participants.
        Am J Manage Care. 2013; 20: e535-e536
        • Tomita N.
        • Yoshimura K.
        • Ikegami N.
        Impact of home and community-based services on hospitalisation and institutionalisation among individuals eligible for long-term care insurance in Japan.
        BMC Health Serv Res. 2010; 10: 345
        • Baldwin R.
        • Stephens M.
        • Sharp D.
        • Kelly J.
        Issues facing aged care services in rural and remote Australia. Aged and Community Services Australia.
        2013 (Available at:) (Accessed September 8, 2017)
        • Karmel R.
        • Anderson P.
        • Gibson D.
        • et al.
        Empirical aspects of record linkage across multiple data sets using statistical linkage keys: The experience of the PIAC cohort study.
        BMC Health Serv Res. 2010; 10: 41
        • Davis J.
        • Morgans A.
        • Burgess S.
        Information management in the Australian aged care setting: An integrative review.
        Health Inf Manage J. 2017; 46: 3-14
      2. Australian Bureau of Statistics. Australian demographic statistics, June 2016. Cat. no. 3101.0. Canberra: ABS.

        • Icon Global
        Carelink+ Community Care Software and Solutions.
        (Available at:) (Accessed September 8, 2017)
        • Douglas H.E.
        • Georgiou A.
        • Tariq A.
        • et al.
        Implementing information and communication technology to support community aged care service integration: Lessons from an Australian aged care provider.
        Int J Integrated Care. 2017; 17: 1-13
        • Schemper M.
        • Smith T.L.
        A note on quantifying follow-up in studies of failure time.
        Control Clin Trials. 1996; 17: 343-346
        • Sarle W.S.
        Cubic Clustering Criterion. SAS Technical Report A-108.
        SAS Institute Inc, Cary, NC1983
        • Andersen R.M.
        Revisiting the behavioral model and access to medical care: Does it matter?.
        J Health Social Behav. 1995; 36: 1-10
      3. Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS): Correspondences, July 2011. Cat. no. 1270.0.55.006. Canberra: ABS.

        • Samsa P.
        • Ramsay L.
        • Owen A.
        • et al.
        The Australian Community Care Needs Assessment (ACCNA): Towards a national standard.
        Centre for Health Service Development, University of Wollongong, Wollongong2007 (Available at:) (Accessed September 8, 2017)
        • Fine J.P.
        • Gray R.J.
        A proportional hazards model for the subdistribution of a competing risk.
        J Am Stat Assoc. 1999; 94: 496-509
        • Royston P.
        • Moons K.G.
        • Altman D.G.
        • Vergouwe Y.
        Prognosis and prognostic research: Developing a prognostic model.
        Br Med J. 2009; 338: b604
      4. Australian Institute of Health and Welfare. Residential aged care and Home Care 2014–15. Cat. no. WEB 133. 2016. Canberra: AIHW.

        • Weissert W.G.
        The national channeling demonstration: What we knew, know now, and still need to know.
        Health Serv Res. 1988; 23: 175-187
        • Weissert W.
        • Wan T.
        • Livieratos B.
        • Katz S.
        Effects and costs of day-care services for the chronically ill: A randomized experiment.
        Med Care. 1980; 8: 567-584
        • Wooldridge J.
        • Schore J.
        The evaluation of the National Long Term Care Demonstration. 7. The effect of channeling on the use of nursing homes, hospitals, and other medical services.
        Health Serv Res. 1988; 23: 119-127
        • Muramatsu N.
        • Yin H.
        • Campbell R.T.
        • et al.
        Risk of nursing home admission among older americans: Does states' spending on home-and community-based services matter?.
        J Gerontol Ser B Psychol Sci Social Sci. 2007; 62: S169-S178
        • Kendig H.
        • Browning C.
        • Pedlow R.
        • et al.
        Health, social and lifestyle factors in entry to residential aged care: An Australian longitudinal analysis.
        Age Ageing. 2010; 39: 342-349
        • Epstein R.M.
        • Fiscella K.
        • Lesser C.S.
        • Stange K.C.
        Why the nation needs a policy push on patient-centered health care.
        Health Affairs. 2010; 29: 1489-1495
        • Lewis J.
        • West A.
        Re-shaping social care services for older people in England: Policy development and the problem of achieving “good care”.
        J Social Policy. 2014; 43: 1-18