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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J 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 2012Restorative Home Care Long Term Outcomes WA
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Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Gill Lewin, Janine Alan, Helman Alfonso
Long Term Outcomes of Restorative Home Care
IFA May 2012
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Long Term Outcomes
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
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
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
WA
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
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
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
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.
IFA May 2012
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
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
IFA May 2012
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
Results - Demographics
IFA May 2012
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
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Results – HACC All Service Use
IFA May 2012Restorative Home Care Outcomes
2040
6080
100
% re
quiri
ng s
ervi
ces
0 12 24 36 48 60Months of follow up
Control PEPHIP
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
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
Results – HACC Personal Care Use
26.10.2011
020
4060
8010
0%
requ
iring
ser
vice
s
0 12 24 36 48 60Months of follow up
Control PEPHIP
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
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
Results – ACAT assessment over time
IFA May 2012
Year acap ControlN=2,332
PEPN=5,450
HIPN=2,586
200414 (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 ControlN=2,332
PEPN=5,450
HIPN=2,586
appcomm 191 (3.90) 176 (3.23) 87 (3.36)
appeach 127 (1.16) 22 (0.40) 13 (0.50)
appother 199 (4.25) 204 (3.74) 94 (3.63)
appresi 186 (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)
PEP0.64 (0.52-0.79) 0.96 (0.75-1.22)
HIP0.65 (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
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
Results – Risk of death
IFA May 2012
0.5
11.
5C
umul
ativ
e M
orta
lity
Rat
e
0 2 4 6Years of follow up
Control PEPHIP
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
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
Results – Adjusted Median Cumulative Costs
IFA May 2012
*Adjusted for age, sex, living arrangement, having carer, dependence level and requiring PC service previous start study
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
Returns on Investment
IFA May 2012
*Adjusted for age, sex, living arrangement, having carer, dependence level and requiring PC service previous start study
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
ConclusionsIndividuals 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
IFA May 2012
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Restorative Home Care Outcomes
Contact for more information:
IFA May 2012