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J Am Med Dir Assoc. 2020 Jan 31. pii: S1525-8610(19)30832-1. doi: 10.1016/j.jamda.2019.11.023. [Epub ahead of print]

Impact of Prior Home Care on Length of Stay in Residential Care for Australians With Dementia.

Author information

1
Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: h.welberry@unsw.edu.au.
2
Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
3
Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.

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:

Dementia; home care; home support; long-term care; nursing home; residential care

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