Costs Of Residential Care Research Articles

HOW CAN DYING, DEATH, LOSS AND BEREAVEMENT BE INCORPORATED IN THE POLICY AND PRACTICE OF AGING IN PLACE?

Abstract ‘Aging in place’ has been one of the key goals for policymakers in the last 20 years, often translated into policies of deinstitutionalization. Due to the high costs of residential care, the home has re-emerged as a key site for the provision and consumption of care and support. Several critiques of this evolution have been formulated, including the challenges ageing in place might represent for older people, leading to reduced quality of life, and the need to consider low quality of older people’s houses, meaning that older people’s homes might not be the “best” places to age. However, what has received too little attention in the whole “aging in place” discourse is the end-of-life. This symposium addresses this by illustrating that we cannot talk about ageing in place without talking about dying in place. The authors present research on how dying, death, loss and bereavement might be included in the ageing-in-place policy and practice: Doran sets the stage with a critical reflection of ageing in place and the need to reflect on joining up ageing in place and end-of-life theory and practice. Smetcoren reports on the development of a ‘maison de mourance’ in a ‘co-housing and co-caring’ project in Brussels. Dury discusses consolation spaces in Flanders and how they decrease the taboo on death, grief and loss in the neighborhood. And Stegen reports on the caring neighbourhood-movement in Belgium and how some orient themselves to becoming part of a worldwide network of ‘compassionate communities’.

Estimating the Social Costs of Child Abuse in Residential Care for Children with Disabilities Using the Japanese Survey on the Interactions of Adverse and Positive Childhood Experiences toward Adulthood

We sought to calculate the extra social costs resulting from child abuse in residential care facilities (RCFs) for children with disabilities (CWD) in Japan. We distributed a survey to 260 residential facilities for CWD in 2020 and obtained responses from 91 facilities. Among the children placed in these facilities, our estimates by four different criteria determined that 23-67% were affected by child abuse. We also estimated extra costs for each of the four criteria, which we estimated to average USD 647.7 million. This study is meaningful in that there are no existing official statistics or research findings on the extra costs of residential care due to child abuse in Japan.

Perspectives on Wider Integration of the Health-Assistive Smart Home

Most older adults desire to be as independent as possible and remain living in their ancestral home as they age. Aging-in-place maximizes the independence of older adults, enhancing their wellbeing and quality of life while decreasing the financial burden of residential care costs. However, due to chronic disease, multimorbidity, and age-related changes, appropriate conditions are required to make aging-in-place possible. Remote monitoring with smart home technologies could provide the infrastructure that enables older adults to remain living independently in their own homes safely. The health-assistive smart home shows great promise, but there are challenges to integrating smart homes on a larger scale. The purpose of this discussion paper is to propose a Design Thinking (DT) process to improve the possibility of integrating a smart home for health monitoring more widely and making it more accessible to all older adults wishing to continue living independently in their ancestral homes. From a nursing perspective, we discuss the necessary stakeholder groups and describe how these stakeholders should engage to accelerate the integration of health smart homes into real-world settings.

Development of Adapt-ABLE smart system – an end-to-end system for speeding up disabled housing adaptation process

PurposeThe problem of long delay and waiting time in Disabled Facilities Grants (DFG) housing adaptation has been ongoing for years. This study aimed at constructing an innovative smart solution to streamline the housing adaptation process to prevent lengthy delays for disabled and elderly people.Design/methodology/approachThe Adapt-ABLE approach is suggested based on a constructive research approach, where extensive theoretical development of the Adapt-ABLE concept is developed. It consists of four integrated platforms that undergo theoretical and analogical development and validations through applicable theories, a workshop, four brainstorming sessions and a focus group.FindingsThe proposed Adapt-ABLE approach utilises process optimisation techniques through an IT system for streamlining the process. The merits of the semi-automated system include the development of a preventive measure that allows measurement of suitability index of homes for the occupants, indicative assessment that shorten the application duration, procurement and contracting platform that utilises principles based on framework agreement and call-off contract, and a platform that standardised performance management for continuous improvement.Originality/valueThe Adapt-ABLE solution will cut the application journey of non-qualified applicants and suggest where help can be sought. The qualified applicants' application journey will also be shortened through an online indicative assessment regime and early online resources (means) testing. Overall, the proposed system reduces the waiting time, and timely delivery improves the applicant's quality of life by living independently. It will potentially save the NHS billions of pounds used to replace hips and residential care costs due to lengthy delays in the housing adaptations process.

Factors influencing community-dwelling older adults' readiness to adopt smart home technology: A qualitative exploratory study.

Ageing-in-place for older people could be more feasible with the support of smart home technology. Ageing in-place may maximize the independence of older adults and enhance their well-being and quality of life, while decreasing the financial burden of residential care costs, and addressing workforce shortages. However, the uptake of smart home technology is very low among older adults. Accordingly, the aim of this study was to explore factors influencing community-dwelling older adults' readiness to adopt smart home technology. A qualitative exploratory study design was utilized. Descriptive data were collected between 2019 and 2020 to provide context of sample characteristics for community-dwelling older adults aged ≥65years. Qualitative data were collected via semi-structured interviews and focus groups, to generate an understanding of older adult's perspectives. Thematic analysis of interviews and focus group transcripts was completed. The Elderadopt model was the conceptual framework used in the analysis of the findings. Several factors influenced community-dwelling older adults' (N=19) readiness to adopt smart home technology. Five qualitative themes were identified: knowledge, health and safety, independence, security and cost. Community-dwelling older adults were open to adopting smart home technology to support independence despite some concerns about security and loss of privacy. Opportunities to share information about smart home technology need to be increased to promote awareness and discussion. Wider adoption of smart home technology globally into the model of aged care can have positive impacts on caregiver burden, clinical workforce, health care utilization and health care economics. Nurses, as the main providers of healthcare in this sector need to be knowledgeable about the options available and be able to provide information and respond to questions know about ageing-in-place technologies to best support older adults and their families.

Potential cost savings for selected non-pharmacological treatment strategies for patients with Alzheimer's disease in Finland.

To compare the costs and monetary benefits of non-pharmacological interventions for patients with Alzheimer's disease in real-world settings. A systematic review was performed to determine the most effective treatment strategies for being able to stay at home for patients with Alzheimer's disease. Care-management, family support, and multidisciplinary rehabilitation were identified as effective interventions applicable in the Finnish healthcare setting. Data on medical and social service costs, and the costs of residential care for all patients newly diagnosed with Alzheimer's disease in 2 major cities in Finland were analysed in a 4-year follow-up study. The potential cost savings of the different treatment strategies were assessed. The annual cost increased from €9,481 to €28,400 (mean per patient) during the 4-year follow-up. Cost savings were achieved in care-management, family support programmes, and rehabil-itative cognitive and social activation if the patients' transition to long-term care was delayed by 2.8, 1.8 and 43.0 days, respectively. Care-management and informal caregiver support for patients with Alzheimer's disease may benefit patients and result in concurrent cost savings. Delaying the decline in cognitive and social functioning through rehabilitation is indicated for more severe phases of Alzheimer's disease, and the costs appear to be compensated by savings in the cost of long-term care.

Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life.

To compare the outcomes and costs of clustered domestic and standard Australian models of residential aged care. Cross-sectional retrospective analysis of linked health service data, January 2015 - February 2016. 17 aged care facilities in four Australian states providing clustered (four) or standard Australian (13) models of residential aged care. People with or without cognitive impairment residing in a residential aged care facility (RACF) for at least 12 months, not in palliative care, with a family member willing to participate on their behalf if required. 901 residents were eligible; 541 consented to participation (24% self-consent, 76% proxy consent). Quality of life (measured with EQ-5D-5L); medical service use; health and residential care costs. After adjusting for patient- and facility-level factors, individuals residing in clustered models of care had better quality of life (adjusted mean EQ-5D-5L score difference, 0.107; 95% CI, 0.028-0.186; P = 0.008), lower hospitalisation rates (adjusted rate ratio, 0.32; 95% CI, 0.13-0.79; P = 0.010), and lower emergency department presentation rates (adjusted rate ratio, 0.27; 95% CI, 0.14-0.53; P < 0.001) than residents of standard care facilities. Unadjusted facility running costs were similar for the two models, but, after adjusting for resident- and facility-related factors, it was estimated that overall there is a saving of $12 962 (2016 values; 95% CI, $11 092-14 831) per person per year in residential care costs. Clustered domestic models of residential care are associated with better quality of life and fewer hospitalisations for residents, without increasing whole of system costs.

Direct health and residential care costs of people living with dementia in Australian residential aged care.

ObjectivesThis analysis estimates the whole‐of‐system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.MethodsData were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals.ResultsThe average annual whole‐of‐system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out‐of‐hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia.ConclusionThis study provides the first estimate of the whole‐of‐system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom‐up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top‐down, population costing approaches are taken.

The economic impact of moderate stage Alzheimer's disease in Italy: evidence from the UP-TECH randomized trial.

There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families. This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community. The societal burden of AD, composed of public, patient, and informal care costs, was about €20,000/yr. Out of this, the cost borne by the public sector was €4,534/yr. The main driver of public cost was the national cash-for-care allowance (€2,324/yr), followed by drug prescriptions (€1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at €13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure. The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org ( NCT01700556).

Costs and benefits of home care for the elderly versus residential care: a comparison using propensity scores

A comparison of the costs of residential care and home care shows that the former is more expensive for society. However, elderly people seem to be happier in residential care. All stakeholders, except the state (and thus the taxpayer), benefit if elderly people enter residential care. This reveals that payment systems in the Netherlands contain adverse incentives stimulating entry into residential care. The research is based on surveys of older people in the Netherlands living at home and those living in residential care homes in the period 2007-2009. Propensity score matching is used to match people living at home with those living in residential care. All costs of living and health care are compared for these two groups.

Unpaid carers hold the key to sustainable social care: Is it time they got the credit?

AbstractThis paper reviews the challenges faced by unpaid family carers and the current support and services available to them. It argues that current carer support should be built on and presents the evidence for doing so, including evidence of the opportunities to make substantial savings in residential care costs. The paper suggests a new way in which proposed resource allocation and personal budget systems could be developed in order to sustain caring, avoiding the risk of a new perverse incentive to families to end caring roles. The paper provides some modelling of the costs and benefits of this approach.

Think tank presents plan to ease cost of residential care.

A THINK TANK that analyses social problems has laid out a four-point plan that it wants the government to introduce to help older people pay for residential care.

What is the (Net) Cost to Government of Homelessness Programs?

Homelessness programs may improve the health, well‐being, financial security, labour market and housing outcomes of clients. This, in turn, may result in decreased utilisation of health and justice services, reduced child residential care costs, lower housing management costs, lower income support payments and higher revenue from increased income tax payments. When costed, such impacts represent whole‐of‐government savings or cost offsets to the provision of homelessness programs. This paper provides indicative estimates of the value of potential savings or cost offsets in two areas, namely, the health and justice fields from homelessness program interventions. Our key finding is that homelessness programs have the potential to save over twice the value of the capital and recurrent funding of homelessness programs on the basis of health and justice cost offsets alone.

Enabling Older People to Stay at Home: The Costs of Substituting and Supplementing Care with Assistive Technology

A wide-ranging multiprofessional research project explored issues relating to the introduction of assistive technology into the existing homes of older people in order to provide them with the opportunity to remain at home. The financial relationship between assistive technology and packages of formal care was also explored. The costs of residential care and those of a number of packages containing differing quantities of assistive technology, formal care and informal care were compared. The analyses provide a strong financial case for substituting and/or supplementing formal care with assistive technology, even for individuals with quite disabling conditions. Although needs and hence the cost of provision rise with an increasing level of disability, the savings in care costs accrue quickly. The consideration of a variety of users with different needs and informal care provision, and occupying a very wide range of housing, leads to the conclusion that in comparison with traditional care packages, at worst, incorporating significant amounts of assistive technology into care packages is cost neutral, but that with careful specification of assistive technology major savings are feasible.

Extra care housing: a concept without a consensus

Extra care housing has developed from sheltered housing and has increasingly been seen as a popular option by policy‐makers for a number of reasons. These include the inability of conventional sheltered housing to be an adequate solution for a growing population of very old people, the decline in popularity and high costs of residential care and perceived problems with older people staying in mainstream housing. There is, however, no agreed definition of extra care housing, even though a growing number of government grants are becoming available for this type of housing. This is causing confusion for providers and for older people and their families who are not sure exactly what is provided. This lack of clarity means that this form of housing has become an erratic and piecemeal form of provision.

Paediatric home care: a systematic review of randomized trials on costs and effectiveness

To review systematically randomized trials (RCTs) on the effectiveness and costs of paediatric home care. National Health Service (NHS) Centre for Reviews and Dissemination guidelines were followed. In all, 20 electronic and other sources were searched, using specially designed strategies. Economic studies and other selected designs were included, but only RCT findings--on service use, clinical outcomes, costs, and impact on the family--are reported here. Analysis is descriptive, with pooled standard mean differences used where meta-analysis was possible. About 1730 identified records up to August 2001 were potentially relevant. In all, 10 RCTs (24 papers) were finally included, covering five types of paediatric home care--for very low birth weight or medically 'fragile' infants, for asthma or diabetes, for technology-dependent children, for mental health, and generic home care. Paediatric home care may enhance physical and mental development for very low birth weight infants and may be cheaper but the evidence is not strong. Home care for diabetes or asthma may reduce parents' costs with some clinical but no social differences noticeable. No randomized trials for technologically dependent children were found. Home care for mental health may increase parental satisfaction with services and reduce some health service and residential care costs. Generic home care showed no clinical effects at early follow-up. Partial follow-up after five years suggested improved psychological adjustment. No cost data were available for this care model. Despite recent expansion, research evidence from randomized trials for paediatric home care is slight, and methods used are weak in places. Paediatric home care poses practical and ethical questions that cannot be addressed by RCTs.

Residential care for mentally ill people in Andalusia and London - a comparison of care environments, users' attitudes and cost of care

Background: This collaborative study evaluates newly developed residential facilities in Andalusia and compares them with the established care network in London. Aims: The study aims to discover the similarities and differences in the quality and effectiveness of residential care provision in the two regions. Method: A comparative study of matched samples, comprising 136 former long-stay psychiatric patients living in 30 community facilities in Andalusia and London. Domains explored included: the demographic and social profiles of residents, objective measures of care environments, cost of residential care and attitudes of service users. Residents and facilities were assessed, using a batch of cross-translated schedules with established psychometric properties. A cost related analysis was conducted using the Client Service Receipt Interview (CSRI). Results: While residents in both locations are equally disabled the level of support is significantly higher in London than in Andalusia. The Andalusian facilities are more restrictive in management policies, offering less privacy to their residents. A higher proportion of staff in Andalusia are professionally qualified, but the training opportunities for British staff are greater. Both British and Andalusian residents prefer living in the community. The average cost of residential care is markedly higher in London than in Andalusia. Conclusions: There is a need to extend the network of residential facilities in Andalusia and apply less restrictive policies. The cost-effectiveness of staffed group homes should be scrutinised and professionalism among British residential staff increased.

Secondary analysis of economic data: a review of cost-benefit studies of neonatal screening for phenylketonuria.

STUDY OBJECTIVE: To estimate the net financial benefit of neonatal screening for phenylketonuria (PKU): by a simple pooling of cost data from the literature; and by a more complex modelling...

The mental health residential care study: predicting costs from resident characteristics.

Little information is available on the costs of residential care for people with mental health problems, and there are very few research data on how or why the costs of provision vary. As part of a broader study based on data collected from across the residential care sectors in eight districts and using multiple regression analysis, research has examined whether and which resident characteristics are associated with higher or lower costs. Resident characteristics account for approximately 21% of the observed variation in inter-resident costs. Separate analyses were conducted for people in the London and non-London districts. The resident characteristics that were found to be significant predictors of cost include: age, gender, ethnic group, history of psychiatric admissions, diagnosis, emotional lability, daily living skills, social interaction and network, aggression, suicidal tendencies, drug abuse and legal status. Examination of the residual ('unexplained') costs found significant differences between facility types, sectors (private and voluntary being less costly than public, other things being equal) and districts. The associations uncovered by these analyses can inform commissioners' planning and purchasing activities, at both the macro and micro levels, by revealing those resident needs and circumstances that are associated with higher costs.

The Cost of Residential Care for the Elderly: The Effects of Dependency, Design and Social Environment

ABSTRACTDespite the important role played by cost considerations in policy decisions regarding services for the elderly there has been relatively little reliable research on this topic. A large nationally representative survey of old people's homes conducted by the Personal Social Services Research Unit in England and Wales in 1981 provides a firm foundation for the careful examination of the cost of residential care. Focusing on residential homes in the public sector, the cost function analyses reported in this paper have a number of policy implications. The empirical results help to explain cost inflation and allow the prediction of future cost trends, they inform ‘balance of care’ discussions and inter-authority and inter-sectoral comparisons, and they provide evidence on the cost implications of scale, group-living design, day care and sheltered housing. Finally, the relationship between cost and social environment (a central component in any quality of care assessment) is examined. The results suggest that there is no significant association between the two.