Abstract
Objectives
To assess the impact of home care on length-of-stay within residential care.
Design
A retrospective observational data-linkage study.
Setting and Participants
In total there were 3151 participants from the 45 and Up Study in New South Wales,
Australia with dementia who entered residential care between 2010 and 2014.
Methods
Survey data collected from 2006‒2009 were linked to administrative data for 2006‒2016.
The highest level of home care a person accessed prior to residential care was defined
as no home care, home support, low-level home care, and high-level home care. Multinomial
logistic regression and Cox proportional hazards were used to investigate differences
in activities of daily living, behavioral, and complex healthcare scales at entering
residential care; and length-of-stay in residential care.
Results
People with prior high-level home care entered residential care needing higher assistance
compared with the no home care group: activities of daily living [odds ratio (OR)
3.41, 95% confidence interval (CI) 2.14‒5.44], behavior (OR 2.61, 95% CI 1.69‒4.03),
and complex healthcare (OR 2.02, 95% CI 1.06‒3.84). They had a higher death rate,
meaning shorter length-of-stay in residential care (<2 years after entry: hazard ratio
1.12; 95% CI 0.89‒1.42; 2-4 years: hazard ratio 1.49; 95% CI 1.01‒2.21). Those using
low-level home care were less likely to enter residential care needing high assistance
compared to the no home care group (activities of daily living: OR 0.61, 95% CI 0.45‒0.81;
behavioral: OR 0.72, 95% CI 0.54‒0.95; complex healthcare: OR 0.51, 95% CI 0.33‒0.77).
There was no difference between the home support and no home care groups.
Conclusions
High-level home care prior to residential care may help those with dementia stay at
home for longer, but the low-level care group entered residential care at low assistance
levels, possibly signaling lack of informal care and barriers in accessing higher-level
home care.
Implications
Better transition options from low-level home care, including more timely availability
of high-level care packages, may help people with dementia remain at home longer.
Keywords
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Article info
Publication history
Published online: January 31, 2020
Footnotes
HW was supported by an Australian Government Research Training Program scholarship and through funding from the National Health and Medical Research Centre Boosting Dementia Research grant (Grant#1095097).
The authors declare no conflicts of interest.
Identification
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
