Home-based Healthcare Services Research Articles

Balancing between dual belongings when organised into interdisciplinary teams, with the trust model as the context: A qualitative study

BackgroundHome-based healthcare services are facing challenges and pressures of increasing needs due to an ageing population, rising workload for an overburdened workforce, and limited financial resources. The trust model is an approach to address the challenges, by organizing the home-based healthcare services into smaller, autonomous interdisciplinary teams. The aim is to involve users and next of kin in decision-making and trusting frontline workers’ professional judgement, thus making the services more flexible and individually tailored. This study explores frontline workers’ practices and experiences of working within interdisciplinary teams according to the trust model’s goals.MethodsObservations, individual-, and focus groups interviews were conducted within home-based healthcare service in a Norwegian municipality. The participants were leaders and frontline workers at different levels of the home-based healthcare services, including registered nurses, auxiliary nurses, occupational therapists, physiotherapists, and other unskilled healthcare personnel. Data was analysed thematically.ResultsThe results are presented in terms of themes: ‘We all want the best for service users’, ‘Belonging to an interdisciplinary team’ and ‘Maintaining belonging to those with similar work tasks and responsibilities’. The results show a diversity among the participants’ experiences of working within interdisciplinary teams. It demonstrates a dilemma between creating belonging to and forming identities within the interdisciplinary team, and at the same time, the importance of maintaining belonging and identity with those in the same profession or with the same tasks and responsibilities.ConclusionThis study suggests that the frontline workers need for dual belonging seems to be underestimated within the trust model, and by acknowledging this, organisations and policymakers can create environments that support both. Which in turn can enhance the possibility to deliver flexible and individually tailored services for service users.

Unspoken expectations and situational participation: a qualitative study exploring the instantiation of next of kin involvement within the trust model

BackgroundDemographic changes, such as an increase in older adults, present a challenge to the healthcare service’s current capacity. Moreover, the need for healthcare personnel is rising, while the availability of labour is dwindling, leading to a potential workforce shortage. To address some of these challenges, enhanced collaboration between home-based healthcare frontline workers, service users, and next of kin is a necessity. The trust model is an organisational model where home-based healthcare services are organised into smaller interdisciplinary teams aiming to tailor the services in collaboration with service-users and their next of kin’. This study explores how the next of kin and frontline workers perceive and perform involvement in making decisions regarding tailoring the services for the users of home-based healthcare services organised after the trust model.MethodsFour in-depth interviews and 32 observations were conducted, and thematic analysis was employed to identify meaningful patterns across the datasets.ResultsThe results are presented as two themes: (i) unspoken expectations and (ii) situational participation. The results highlight the complex nature of next-of-kin involvement and shared decision making, raising questions about meeting expectations, evaluating available resources, and developing sustainable involvement processes.ConclusionThis study indicates that despite of an interdisciplinary organisational model aiming for shared decision making as the trust model, the involvement of next of kin continues to be a challenge for frontline workers in home-based healthcare services. It also points to the importance of transparent communication and how it is deemed essential for clarifying implicit expectations.

Psychotrophic Medication Prescriptions and Polypharmacy in Geriatric Patients Followed up in a Home-based Health Care Setting

IntroductionBy 2050, one out of every six people in the world will be 65 years or older. Chronic diseases and associated multiple drug use are common in elderly. The use of five or more drugs is called polypharmacy and it’s reported between 40-90% in the elderly. The Beers Criteria is the American Geriatrics Association’s guide to current recommendations regarding the safety of pharmacotherapy in older age. Being a part of community-based health services in Türkiye since 2005, “Home-based Health Care Services” is a program in which patients, who are mostly elderly and have difficulty in accessing health institutions, access medical services at their homes.ObjectivesIn our study, it was aimed to examine the chronic disease diagnoses and prescriptions of patients aged 65 and over, registered in a home-based health care unit, in terms of psychotropic drugs and polypharmacy, and to evaluate the compliance of their psychiatric prescriptions with the Beers Criteria.MethodsSociodemographic, psychiatric diagnosis and treatment prescription and home-based health service-specific data were collected from the electronic files of home-based health care unit patients. Chronic diseases were scored according to the Modified Charlson Comorbidity Index (mCCI). The last 6-month prescriptions obtained from the electronic patient files were scanned and included in the analysis. In statistical analysis using SPSS Version 25, a p-value of significance <.05 was determined.ResultsAs of February 2023, 229(83.2%) of 275 patients aged 65 and over constituted the research sample. The mean age of the sample, half of whom were considered as oldest-old(85 years and older), was 83±7.97(median=86,IQR=10.75), 69.9%(n=160) were women and 97.8%(n=224) were diagnosed with at least one chronic disease. The mean mCCI scores were 5.30±1.11(median=5.50, IQR=1.0). Polypharmacy was detected in 78.6% of the sample(n=180), among half(n=114) of whom at least one psychotropic was prescribed, drugs not recommended to be prescribed according to the Beers Criteria in elderly patients were 46%(n=52). Prescription rates were as follows: anti-dementia- 21.5%(n=49), antidepressants- 31.1%(n=71), antipsychotics- 21.5%(49) and benzodiazepines- 5.3%. Most frequently prescribed antidepressant was escitalopram 49.2%, while most frequently prescribed antipsychotic was quetiapine 29.4%. The frequency of quetiapine prescription increased significantly in patients with dementia (Χ²(1)=29.54, p<.001) and insomnia (Χ²(1)=13.11,p<.001).ConclusionsThe frequency of polypharmacy was found to be closer to the higher values reported previously. Almost half of the sample had a prescription for psychotropic drugs, and one out of two of these prescriptions did not meet the Beers Criteria. Considering the aging population, it will be of great importance for clinicans to carefully evaluate psychotropic prescriptions and polypharmacy.Disclosure of InterestNone Declared

Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-Funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital.

The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments. However, scientific evidence regarding the association between home-based healthcare services and emergency department uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for emergency department visits among patients receiving publicly-funded homecare services. The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and emergency department visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned emergency department utilizations. Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio (OR)=1.33, 95% CI=1.05 to 1.70), male caregiver (OR=0.18, 95% CI=0.05 to 0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95 to 1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of emergency department utilizations within previous past year before enrollment (OR=1.54, 95% CI=1.14 to 2.10) as significant determinants for unplanned emergency department visits. The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent emergency department visits among patients receiving homecare services.

Reforming for trust and professionalism in municipal healthcare services: implications for human resource management

BackgroundMany countries face an increasing demand for home-based healthcare services, and consequently experience a mismatch between expectations and available financial and human resources. It is therefore important to utilize human resources more efficiently, while at the same time offer jobs that attract the professionals they need. This article reports a study of the development and piloting of a new organizational model for home-based healthcare services in a Norwegian municipality, which addresses the need to provide efficient services and enhance trust and professionalism within healthcare services by improving work autonomy and involvement of employees.MethodsThe research project this article draws its empirical material from was commissioned by the municipality piloting the new organizational model and executed in collaboration with the municipality based on an evaluative trailing research (ETR) design. The data consists of interviews with key personnel and knowledge exchange between researchers and the involved actors in the pilot project. 20 semi-structured interviews involving a total of 34 informants were conducted.The analysis emphasises how different employee groups and management perceived and experienced various aspects of the work situation, as they were introduced to working and managing within the new organizational model. The aim is to shed light on how these employees and managers feel about it, interpret it, and respond to it.ResultsOverall, the results indicate that the model holds potential for realizing the benefits it aims for. However, there were also challenges that need resolving for the model to fulfil this potential. Central elements include clarification of roles and responsibilities for employees and managers, competence specification and development, and development of structures for inter-professional cross-team collaboration and information provision.ConclusionsTrust reform initiatives may be a strategy for fostering high-involvement work systems. To achieve this, sufficient attention must be paid to ensuring structures for information exchange and knowledge development in the early phases of implementation, or preferably prior to implementation. The theoretical model applied in this study could potentially be a useful managerial tool in preparing for and implementing trust reforms in healthcare services.

Interdisciplinary frontline teams in home-based healthcare services—paradoxes between organisational work structures and the trust model: a qualitative study

BackgroundAchieving access to quality healthcare services to ensure healthy lives and promote well-being for all at all ages is one of the United Nation’s Sustainable Developments Goals. In view of this goal, sustainable community healthcare services in Norway need to be urgently restructured in light of demographic changes, including an increase in the percentage of older adults in the country. National healthcare policies recommend finding new ways to organise and perform services using new technology, new methods and new solutions. The goal is to ensure greater continuity in the provision of services and softer transitions that enable service users to deal with a smaller number of people. The trust model is one such suggested organisational approach. The goal of the trust model is to involve service users and their next of kin in decisions that concern them while also trusting frontline workers’ professional judgement in assessing the need for services and adjusting them to address changes in the health of the users, thus making the services individually tailored and more flexible. This study aims to explore how organisational work structures influence the delivery of interdisciplinary home-based healthcare services.MethodsObservations, individual-, and focus groups interviews were conducted within community home-based healthcare services in a large Norwegian city with managers at different levels, nurses, occupational therapists, physiotherapists, purchaser-unit employees and other healthcare workers. Data was analysed thematically.ResultsThe results are presented in terms of themes— “Balancing on the margins: Negotiations between the time available, users’ needs, unforeseen events and administrative tasks” and “One gathered unit, but with different work structures”. The results identify organisational work structures that influence the performance of the trust model with regard to its intention of making flexible and individually tailored services available. However, these structures are different for the members of the interdisciplinary team, thus creating several paradoxes that need to be negotiated while fulfilling their daily responsibilities.ConclusionThis study suggests that it is crucial to pay attention to paradoxes and structures experienced by interdisciplinary frontline workers in home-based healthcare services, since they are unavoidable factors that need to be acknowledged when designing approaches for addressing the changes expected in community healthcare services.

Healthcare professionals' experiences of providing care for patients with enterocutaneous fistula in hospital and in homecare: A qualitative study.

Enterocutaneous fistula is a rare but complex and serious condition that is both physically and psychologically demanding for the person affected. Infection, fistula dressing problems, electrolyte and fluid imbalance and malnutrition render the individual in need of long periods of in-hospital care and homecare. This place great demands on patients, families, and healthcare professionals. More research is needed to bridge the gap between hospital and home-based healthcare services. To explore healthcare professionals' experiences of providing care for patients with enterocutaneous fistula in hospital and in homecare. A qualitative descriptive study design based on five focus group interviews involving 20 healthcare professionals. Data was analysed using content analysis. Three categories with seven corresponding subcategories were developed; 1) Providing care for patients with enterocutaneous fistula in the hospital and at home was complex and time and resource consuming. Participants were struggling with practical issues and lacked disease-specific knowledge and skills; 2) Caring requires an integrated approach but it was challenging to work interprofessionally and cope with barriers in collaboration between providers; 3) Building long lasting relationships with patients and their families was fundamental to the caring process. Participants needed to hide their own feelings related to smell and appearance of the fistula as well as frustration when the fistula dressing did not hold without leaking. The healthcare professionals expressed that the involvement of the patient and their close family was important when proving care, likewise, to have a great understanding of the patients' suffering. The care of patients with enterocutaneous fistula is complex and means engagement for long periods, both in hospital and in home-based healthcare. Regular team meetings of the multidisciplinary team, careful planning before discharge and providing person-centred care can facilitate the care process.

Clinical trials tranformation intiative-decentralized clinical trials: a review article

In clinical research, Decentralized clinical trials (DCTs) can provide opportunities to maximize efficiencies. Unlike the traditional clinical trial model, Decentralized Clinical Trials (DCTs) promote telemedicine, mobile/local healthcare providers (HCPs), mobile/web-based technology, and direct distribution of Investigational Medicinal Products (IMP) to patients, among other things. Hence, DCTs are in the spotlight as technology, infrastructure, and knowledge providing a backbone in clinical research.
 Background: Advances in electronic communication, data storage, emerging technologies, and biosensor development provides new opportunities to exchange information, such as the patient is tested from their home locations and are with locations distant from the investigator. Trials that take place at locations distant from the investigator (i.e., spectrum: CCTs → Hybrid Models → DCTs) in any or all study-related procedures and data is collected electronically fall in the category of the decentralized clinical trial. Trials should be designed to integrate the current healthcare system of the study subject, optimize convenience for study subjects and take advantage of existing programs and data sources including The study subjects themselves through the utilization of telecommunication, videoconferences, mobile or internet-based tools for patient reporting, mobile technology tools and biosensors. Local healthcare providers, home-based healthcare services, pharmacies, clinics, regional hospitals, their perceived obstacles have impeded the widespread use of mobile devices in clinical trials. To encourage solutions to these challenges, The Clinical Trial Transformation Initiative (CTTI) has released best practices and practical methods to advance solutions to these issues that clinical trial sponsors can now use.
 Conclusion: Decentralized clinical trials are not only operationally feasible and show high recruitment rates, have better compliance, lower dropout rates, and are conducted faster. DCT meets the goal of the industry in being low-risk, high returns trials and can offer a reliable, time-based, and cost-effective approach.

Needs-led research: a way of employing user involvement when devising research questions on the trust model in community home-based health care services in Norway

BackgroundThis paper presents a user involvement process, called needs-led research, conducted as a part of a doctoral degree project aiming to explore research priorities and, ultimately, to develop a final top 10 list of questions relevant to the field of research. There is evidence of a mismatch between what user groups within a research field find relevant to study and what is actually being done. User involvement is a method that can accommodate this, and there is a growing attention and amount of research in this field based on an understanding that people who receive health care services, and their next of kin and clinicians, are uniquely positioned to contribute to research in order to understand their experiences better and improve the services. This paper presents a user involvement process in a small-scale study, referred to as needs-led research, which concerns the ‘performance of the trust model in community home-based health care services’. The process was conducted as part of a doctoral degree project.MethodThe needs-led research process is inspired by the James Lind Alliance (JLA), which focuses on bringing together service users, next of kin and clinicians on equal terms to explore research priorities. The process consisted of five-steps, each of which involved representatives from service users, next of kin and clinicians: 1) narrowing down the theme; 2) steering group meeting; 3) gathering input through a survey; 4) data processing and interim priority setting; and 5) final priority setting.ResultsAlmost 200 participants contributed during the five steps, 294 inputs were gathered, and 35 participants voted for the top 10 list. The top 10 list is presented.ConclusionThis paper provides an example of how user involvement can be employed to devise research questions that are relevant for clinicians, service users, next of kin and service providers concerning the ‘performance of the trust model in home-based health care’. It also outlines some strengths and limitations of the process. The needs-led research process shows that user involvement in research is feasible for developing research questions in small-scale studies. We hope that the top 10 list presented will encourage future research to address issues of importance regarding the performance of the trust model in community home-based health care services.

Impact of Economic Accessibility on Realized Utilization of Home-Based Healthcare Services for the Older Adults in China.

Home-based healthcare service has gradually become the most important model to cope with aging in China. However, the contradiction between oversupply and insufficient demand of healthcare services is becoming increasingly serious. How to effectively improve the realized utilization of healthcare resources has become a key issue in the development of healthcare services. Based on the social background of “getting old before getting rich”, this article explores the relationship between economic accessibility and realized utilization, and finds that the impact of economic accessibility on realized utilization is inverted U-shaped, not a linear positive effect. In addition, considering the moderating role of family support, it is found that family support can strengthen the inverted U-shaped effect of economic accessibility on realized utilization. Therefore, exerting the role of family and improving economic accessibility can effectively solve the dilemma of low utilization of healthcare services.

Using AI to Implement O2O Home Health Care Program

With the continuous growth of China’s elderly population, the demand for elderly care services has increased dramatically. Due to the influence of Chinese people’s cultural concept of elderly care, most of the elderly are more inclined to home-based care, enjoy the happiness of children and grandchildren, and enjoy family happiness. At present, there are some problems in home-based health care services, such as lack of professional talents and single service mode. This entrepreneurial project which is proposed by Wish Magic has grasped the pain points of China’s elderly care problems, and brought about some problems. Efforts should be made to build a sharing platform for elderly care services, attract professionals to provide professional services for the elderly, and hold diversified activities to meet the material and spiritual needs of the elderly. The planned market strategy of the project is divided into three steps. Firstly, the project will be carried out in the first and second tier cities, and then expanded to the third tier cities. Later, the market will be expanded to the fourth tier cities. At the same time, the project will cooperate with government departments to strive for government funding and policy support, and provide accurate services in combination with online and offline ways, so as to meet the diversified pension needs of the elderly.

Differences in the Potential Accessibility of Home-Based Healthcare Services among Different Groups of Older Adults: A Case from Shaanxi Province, China.

With the increase of the aging population and the lack of family care, home-based healthcare services have gradually become the main model to cope with aging, so local governments have invested heavily in the construction of home-based healthcare services. However, healthcare services still have problems such as low resource utilization and imbalanced development. The reason is that the supply and demand of healthcare services are not matched and the potential accessibility is low. Therefore, based on the supply and demand of healthcare services, this article pulls out the spatial and social factors that affect the potential accessibility, and tests the influence of individual factors on the potential accessibility among different groups of older adults. It is found that the perceived vulnerability of the older adults will reduce the potential accessibility of healthcare services. The psychosocial status, income and education level with the willingness to use healthcare services of the older adults are directly proportional, while residence has a negative impact on the potential accessibility. Finally, based on this finding, this article puts forward feasible suggestions from the perspective of policy content, publicity, and implementation.

Assessing the Accessibility of Home-Based Healthcare Services for the Elderly: A Case from Shaanxi Province, China.

With the rapid increase of the elderly population in China, healthcare services for the elderly have gradually become an important welfare resource. However, the healthcare service for the elderly still has problems such as mismatched supply and demand and unbalanced resources. In order to effectively eliminate the path barriers to match supply and demand, and improve the accessibility of healthcare services, this paper introduces the sustainability of the healthcare service based on the accessibility theory, and constructs an index system from the three dimensions of potential accessibility, realized accessibility, and sustainable accessibility of healthcare services for the elderly. Then, the paper makes a practice application of the index system based on survey data of healthcare services from Shaanxi province, China. Finally, the paper finds that the total accessibility and sustainable accessibility of healthcare services for the elderly in Shaanxi Province are at an average level. The score of potential accessibility is high, indicating that elderly people have greater opportunities to use healthcare services. The realized accessibility score is low, which indicates that the actual use of healthcare services for the elderly presents low satisfaction.

ChainSDI: A Software-Defined Infrastructure for Regulation-Compliant Home-Based Healthcare Services Secured by Blockchains

Healthcare networking and computing infrastructure is rapidly changing from closed environments to open environments that incorporate ubiquitous medical devices and novel application scenarios. For example, home-based healthcare involves the collection and analysis of data from pervasive sensors (often in real time) to guide therapy or to perform medical interventions. In this article, we address the challenges of data interoperability and regulatory compliance when designing and deploying healthcare applications in a heterogeneous home-edge-cloud environment. We propose the ChainSDI framework that leverages the blockchain technique along with abundant edge computing resources to manage secure data sharing and computing on sensitive patient data. We implement programmable ChainSDI application programming interfaces to facilitate the specification of home-based healthcare services running on a software-defined infrastructure (SDI). This article is a collaboration between computer scientists, medical researchers, healthcare IT professionals as well as healthcare providers with the goal of increasing the availability of SDI infrastructures while meeting the performance and regulatory requirements of healthcare applications. Our prototype demonstrates the feasibility of the framework and serves as a testbed for novel experimental studies in the context of emerging healthcare applications.

Strengths and support of older people affected by precarity in South Louisiana.

Few empirical studies have examined strengths and support of older people in circumstances of precarity. A better understanding of this problem has the potential to contribute to the development of care planning and delivery. To investigate how older people deal with episodes of precarity in South Louisiana. More than 300hr of participant observation and interviews were conducted with 20 predominantly older African American women in a housing complex for low-income older persons and two senior citizen centres. The findings demonstrate five central negative conditions of precarity that older people had to manage: (a) loss and discontinuity of home-based healthcare services, (b) stress after loss or disruption of social support, (c) problems of poverty, (d) cognitive impairment and declining health and (e) stress of eviction. Strengths and support that older people used were as follows: (a) spiritual faith, (b) psychological strengths, (c) spiritual relationships, (d) family support, (e) friendships of love and friendships of helpfulness, (f) care and support performed by home-based services, (g) senior centre and housing complex activities, (h) church memberships and activities, and (i) grocery store and café contacts. Home-based services were not sufficient to prevent and reduce precarity for older people because of a lack of and discontinuities in these services. This study adds to the literature about precarity among community-based older people by demonstrating gaps in care support and medication access. The findings suggest that ongoing state funding and support by home-based services are necessary to support frail older people in precarious living conditions to survive and handle stressful life events by reducing vulnerability and enhancing strengths and supportive resources of older people.

Fall risks factors among home-based health care patients in the Aseer province: Observational study

Purpose: To describe the prevalence of fall risks factors using the Missouri Alliance for Home Care’s fall risk assessment tool (MAHC-10) on home-based health care (HHC) patients in the Aseer region, southern Saudi Arabia. Also, to highlight the process of care, and physical therapy utilization among home health care beneficiaries. Method: 242 patients’ information were retrieved and reviewed. Patients in our study received various healthcare services including physical therapy, nursing and physicians’ visits between October and December 2017. We used the MAHC-10, which was designed for assessing multifactorial fall risks among home-based health care patients. Results: 43% of patients were male, and 57% were female. Males received care within an average of 8 d of a referral date, whereas female patients received care within an average of 15 d. Majority of patients are functionally dependent (78%) of patients. Nursing visits were the highest number of professionals that provided HHC visits for both patients’ risk groups. The impairment of functional mobility had the highest fall risk factor among patients receiving HHC services, and fall history factor was the lowest prevalent fall risk factor among patients. Conclusion: Health care utilization is very important, and it should start early enough to decrease the risk of fall especially physical therapy visits. The level of functional mobility was also a most prevalent factor across all home health care patients in our study, and it is an essential element for predicting the likelihood of a fall in the older adult Aseer population.

Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education.

BackgroundPrivacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient’s TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform.MethodsRisk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO’s standard for information security risk management.ResultsA total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring.ConclusionsMost of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality risks in home are different from in a more controlled environment such as a hospital; and electronic equipment located in private homes and communicating via Internet, is more exposed to unauthorised access. By implementing the proposed measures, it has been possible to design a home-based service which ensures the necessary level of information security and privacy.

Costs and determinants of privately financed home-based health care in Ontario, Canada

The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (<90 days of service utilisation) and 256 continuing care clients (>90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed.

The Relationship between Home Based Health Care Services for the Elderly and Health Care Expenditures

The Relationship between Home Based Health Care Services for the Elderly and Health Care Expenditures