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2 lewin-ifa restorative care outcomes
1. Long Term Outcomes
of Restorative Home Care
Gill Lewin, Janine Alan, Helman Alfonso IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
2. 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
Restorative Home Care Long Term Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
3. Silver Chain
WA
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
Restorative Home Care Long Term Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
4. 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
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
5. 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.
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
6. 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
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
7. Results - Demographics
Control PEP HIP
N=2,332 5,450 2,586
Older than 78y 71.6% 49.3% 59.8%
Females 63.4 74.3 78.3
Need carer 26.8 64.6 57.7
Living with others 39.6 60.3 58.5
Previous HAAC 58.1 44.6 48.0
Dependence low 25.5 22.2 19.3
Dependence mod 34.9 44.1 42.7
Dependence high 35.4 6.1 9.6
0 1 2 3 4 5 6 7 8 9 10 11 120.00 0.50 1.00 1.50 2.00
TITLE Prevalence Ratio
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
8. Results – HACC All Service Use
100
Control PEP
HIP
80
*Adjusted for age,
sex, living
arrangement, having
carer, dependence
60
level and requiring
PC service previous
start study
40
20
0 12 24 36 48 60
Months of follow up
Control, n(%) 2002 (90.9) 1068 (65.8) 518 (50.2) 244 (39.2) 111 (33.0) 26 (34.2)
PEP, n(%) 3813 (71.8) 2031 (44.3) 1323 (40.8) 782 (38.5) 382 (37.8) 127 (41.5)
HIP, n(%) 1878 (75.2) 1068 (48.2) 694 (42.8) 428 (40.8) 224 (41.0) 70 (46.7)
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
9. Results – HACC Personal Care Use
100
Control PEP
HIP
80
*Adjusted for age, sex,
living arrangement,
having carer,
60
dependence level and
requiring PC service
previous start study
40
20
0
0 12 24 36 48 60
Months of follow up
Control, n(%) 1886 (85.6) 877 (54.0) 403 (39.1) 183 (29.4) 81 (24.1) 19 (25.0)
PEP, n(%) 1300 (24.5) 336 (7.3) 189 (5.8) 129 (6.4) 58 (5.7) 10 (3.3)
HIP, n(%) 825 (33.0) 224 (10.1) 131 (8.1) 68 (6.5) 34 (6.2) 3 (2.0)
Restorative Home Care Outcomes 26.10.2011
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
10. Results – ACAT assessment over time
Year acap Control PEP HIP outcome level Control PEP HIP
N=2,332 N=5,450 N=2,586 N=2,332 N=5,450 N=2,586
2004
14 (0.60) 10 (0.18) 7 (0.27) appcomm 1
2005 91 (3.90) 176 (3.23) 87 (3.36)
24 (1.03) 27 (0.50) 12 (0.46) appeach 1
2006 27 (1.16) 22 (0.40) 13 (0.50)
30 (1.29) 54 (0.99) 22 (0.85) appother 1
2007 99 (4.25) 204 (3.74) 94 (3.63)
35 (1.50) 78 (1.43) 42 (1.62)
appresi 1
2008
31 (1.33) 68 (1.25) 24 (0.93) 86 (3.69) 160 (2.94) 75 (2.90)
2009 appresi 2
13 (0.56) 19 (0.35) 18 (0.70)
Total
147 (6.30) 256 (4.70) 125 (4.83) 29 (1.24) 20 (0.37) 13 (0.50)
group Crude OR Adjusted* OR (95% CI)
(95% CI) *Adjusted for age, sex, living arrangement, having
carer, dependence level and requiring PC service
previous start study , using Cox regression
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)
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
11. Results – Risk of death
1.5
Control PEP
HIP
group Crude OR Adjusted* OR
Cumulative Mortality Rate
(95% CI) (95% CI)
1
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)
.5
*Adjusted for age, sex, living arrangement,
having carer, dependence level and
requiring PC service previous start study ,
using Cox regression
0
0 2 4 6
Years of follow up
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
12. Results – Adjusted Median Cumulative Costs
*Adjusted for age, sex,
living arrangement,
having carer,
dependence level and
requiring PC service
previous start study
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
13. Returns on Investment
*Adjusted for age,
sex, living
arrangement, having
carer, dependence
level and requiring PC
service previous start
study
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
14. 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
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J
15. Contact for more information:
g.lewin@curtin.edu.au
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J