Abstract
Long-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only. Key findings include the potential to create cost savings from a societal perspective through enhanced staffing levels and quality improvement interventions within residential aged care facilities, while integrated care models, including the integration of health disciplines and the integration between residents and care staff, were shown to have limited cost-saving potential. Six of the 19 identified studies examined dementia-specific structures and processes, in which person-centred interventions demonstrated the potential to reduce agitation and improve residents’ quality of life. Importantly, this review highlights methodological limitations in the existing evidence and an urgent need for future research to identify appropriate and meaningful outcome measures that can be used at a service planning level.
Highlights
The United Nations has reported population ageing in nearly every country in the world and projections suggest that the number of people aged 60 and over will more than double the 2013 level by 2050 [1]
This review focuses on the economic evidence of program features which directly relate to how care is provided in terms of the workforce and its operations and the services provided
Three studies were evaluated from a health care perspective, with resource use and costs calculated for items such as drugs, hospitalisations and outpatient visits
Summary
The United Nations has reported population ageing in nearly every country in the world and projections suggest that the number of people aged 60 and over will more than double the 2013 level by 2050 [1]. Two likely consequences of the ageing population will be an increase in the prevalence of dementia and a growing demand for residential aged care. In most OECD countries, aged care accounts for roughly 1–1.5% of GDP in terms of government funding [4], and on average roughly two-thirds of this funding is allocated to residential care [5]. Given the high prevalence of use of these services among older people, especially the rapidly growing ‘oldest old’, the need for these services is expected to continue to grow, to what extent is likely to depend upon the health status of individuals as they age, the Easton et al Cost Eff Resour Alloc (2016) 14:12 presence of dementia, as well as other social trends, such as the ability of family members to provide informal care. Several recent studies have indicated that for people with dementia with high levels of physical dependence, residential care can be less costly to provide than home-based care [10,11,12]
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