Home Care Utilization Research Articles

Examining the impact of the COVID-19 pandemic on homecare services among individuals with traumatic and non-traumatic spinal cord injuries.

Descriptive repeated-cross sectional retrospective longitudinal cohort study. To investigate the impact of the COVID-19 pandemic on homecare services in individuals with traumatic or non-traumatic Spinal Cord Injury (SCI). Health administrative database in Ontario, Canada. A repeated cross-sectional study using linked health administrative databases from March 2015 to June 2022. Monthly homecare utilization was assessed in 3381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models. Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in personal and/or homemaking services, as well as an increase in nursing visits from April 2020-March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in personal and/or homemaking services in July 2020, as well as an increase in nursing visits from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021. The traumatic group had decreases in personal and/or homemaking services. Both groups had increases in nursing services, increases in case management, and minimal decreases in therapies at varying times during the pandemic. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.

Differences in Healthcare Utilization in Children with Developmental Disabilities Following Value-Based Care Coordination Policies.

To address healthcare spending growth, coordinate care, and improve primary care utilization, a majority of states in the United States have adopted value-based care coordination programs. The objective of this study was to identify changes in national healthcare utilization for children with developmental disabilities (DDs), a high-cost and high-need population, following the broad adoption of value-based care coordination policies. This retrospective study included 9,109 children with DDs and used data from 2002-2018 Medical Expenditure Panel Survey. We applied an interrupted time series design approach to compare pre- and post-Affordable Care Act (ACA) care coordination policies concerning healthcare utilization outcomes, including outpatient visits, home provider days, emergency department (ED) visits, inpatient discharge, and inpatient nights of stay. We found statistically significant increases in low-cost care post-ACA, including outpatient visits (5% higher, p <.001) and home provider days (11% higher, p <.001). The study findings also showed a statistically significant increase in inpatient nights of stay post-ACA (4% higher, p =.001). There were no changes in the number of ED and inpatient visits. Overall, broad implementation of care coordination programs was associated with increased utilization of low-cost care without increases in the number of high-cost ED and inpatient visits for children with DDs. Our study also found changes in population composition among children with DDs post-ACA, including increases in Hispanic (16.9% post-ACA vs. 13.4% pre-ACA, p =.006) and non-Hispanic multiracial children (9.1% post-ACA vs. 5.5% pre-ACA, p =.001), a decrease in non-Hispanic Whites (60.2% post-ACA vs. 68.6% pre-ACA, p =.001), more public-only insurance (44.3% post-ACA vs. 35.7% pre-ACA, p =.001), fewer children with DDs from middle-income families (27.4% post-ACA vs. 32.8% pre-ACA, p <.001), and more children with DDs from poor families (28.2% post-ACA vs. 25.1% pre-ACA, p =.043). These findings highlight the importance of continued support for broad care coordination programs for U.S. children with DDs and potentially others with complex chronic conditions. Policymakers and healthcare leaders might consider improving care transitions from inpatient to community or home settings by overcoming barriers such as payment models and the lack of home care nurses who can manage complex chronic conditions. Healthcare leaders also need to understand and consider the changing population composition when implementing care coordination-related policies. This study provides data regarding trends in hospital and home care utilization and evidence of the effectiveness of care coordination policies before the COVID-19 interruption. These findings apply to current healthcare management because COVID-19 has incentivized home care, which may have a strong potential to minimize high-cost care for people with complex chronic conditions. More research is warranted to continue monitoring care coordination changes over a longer period.

Bringing Delirium to Light: Impact of CAM-ICU Tool to Improve Care Coordination.

Delirium is a serious complication in patients in the critical care unit (CCU) that may lead to prolonged hospitalization if left undetected. The CCU at our hospital does not have a framework for determining delirium that could affect patient outcomes and discharge planning. CCU in a community hospital. A posttest-only design was used for this study. We established a framework for the early assessment of delirium, educated and trained nurses to detect delirium, collaborated with the informatics department, intensivist, nursing, respiratory therapy and worked with case management to deploy the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We used a one-tailed independent t test to determine the impact of CAM-ICU on length of stay (LOS). Cross-tabulation and chi-square tests were used to examine the impact of CAM-ICU tool on home care utilization between the intervention and comparison groups. There was a 3.12% reduction in LOS after implementing the CAM-ICU tool. Also, a reduction in home care service utilization demonstrated statistical significance ( p = .001) between the intervention group (62.5%; n = 177) and the comparison group (37.5%; n = 106). Case managers are essential in improving care transitions. Case managers need to become competent in understanding the implications of the CAM-ICU tool because of their relevant role in the multidisciplinary rounds as advocates to improve care transitions across the continuum of care. Case managers need to have an understanding on how to escalate when changes in the Richmond Agitation-Sedation Scale scores occur during the multidisciplinary rounds because it can affect care coordination throughout the hospital. Implementing the CAM-ICU decreased LOS, and reduced health care utilization. The early identification of patients with delirium can affect the outcomes of critically ill patients and entails multidisciplinary collaboration.

"Technology is the enabler Enhancing “one team, one record, one number, one fund” and connecting Home Care utilization to outcomes for patients and providers”.

Since 2012, St. Joseph’s Health System has been testing and evaluating Integrated Models of Care while maintaining a focused commitment to spreading and scaling sustainable integrated service delivery and integrated funding models.&#x0D; Our collective learnings and expanding partnerships are being celebrated through the creation of the SJHS Centre for Integrated Care. The Centre for Integrated Care, or “CIC”, is an innovation incubator and accelerator powered by the St. Joseph’s Health System (SJHS), the Research Institute of St. Joe's Hamilton, and the partners we work with.&#x0D; We believe getting timely and adequate care should be less complicated: fewer steps, less confusion, less wasted effort, more sharing, and more time to spend with people. Integrated care means integrating people who provide care and the systems they use. We prefer practical and simple innovations that fit within existing resources. Our mission is to integrate systems and remove barriers to advance people-centred care.&#x0D; Our hub includes patients, families/caregivers, care providers, health care leaders, researchers, educators, and technology experts who are united in one goal: to improve the delivery of health and social services for better outcomes.&#x0D; During the presentation we will describe our Integrated Comprehensive Care (ICC) Program for COPD and CHF patients and highlight how the work and in particular the technology, has enabled integration at the micro, meso, and macro levels with a specific focus on equity, access, and provider experience.&#x0D; We will touch on learnings from the pandemic and provide a visual representation linking actual volume and type of home care utilization to outcomes both the year prior to the pandemic and two years during the pandemic; Understanding service delivery trends is important to understanding how resources are contributing to an outcome, such as community staffing decisions impacting hospital lengths of stay. Discussion begins with best practice care standards and pathways. Funding constraints are secondary. The ongoing dialogue between and within acute and home and community care serves to educate and adjust practice as the evidence directs. This approach comes from establishing a shared vision, transparency, trust, and hard work upfront when developing programs. As opposed to command and control, it’s a collective goal to provide the best care within the existing resources and be open to shuffling resources, and looking at other ways of delivering care, including the use of technology, to provide services.&#x0D; Time permitting, we will engage participants in discussions around how we can collectively advance integrated care and suggest opportunities for moving forward.&#x0D; At the end of the day, technology is not the driver in health care. Rather, care is enabled by technology – to support remote access, consistent practice, easily accessible synchronous documentation, ongoing refinement of best practice, and much more. It is essential to the future of health care, meeting client expectations and supporting practitioners to give their best.&#x0D;

EVALUATING AGING IN PLACE LONG-TERM CARE REFORMS: A SCOPING REVIEW

Abstract There is a global trend of reforming long-term care to enable aging in place making it one of the most pressing health policy issues in both high- and low-middle income countries. However, there is no agreement on what is a successful aging in place reform. A holistic perspective that includes clinical, social and economic indicators is required to evaluate these reforms. In this scoping review, we aim to determine the extent of literature on evaluating aging in place reforms. We used the guidance of the JBI Scoping Review Methodology Group to conduct the scoping review. Articles on evaluation of aging in place reform and reporting on any outcome, process or structure quality indicator were eligible for inclusion. The search strategy was performed in Ovid Medline, Ovid Embase, and Ebscohost Academic Search Premier. There were no restrictions on publication year, language, and study design. The search identified 8,107 records. A total of 84 articles met the inclusion criteria and were included in the scoping review. Most studies were quantitative, observational studies from high income countries, using national population level data or larger cohorts. Frequently reported indicators were: total expenditures on long-term care, program spending per capita, hospitalization rates, length of stay, and home care utilization. Less reported were older adult and informal caregiver related indicators like: health, well-being, informal caregiver hours, and sleeping hours. Policy makers can use our findings to develop appropriate strategies to evaluate and monitor their own aging in place reforms.

Diversity of sociodemographic backgrounds and healthcare utilization in cognitively impaired older adults

AbstractBackgroundWith increasing life expectancy, cognitive impairments have become an important public health issue worldwide and in the U.S. Socioeconomically‐disadvantaged populations, including racial/ethnic minorities, are more vulnerable as they have higher rates of underlying conditions and cognitive impairments, such as Alzheimer’s disease and related dementia. With progressive impairments in cognition, behavior, and functionality, patients, families, and healthcare systems face challenges associated with healthcare, including increased costs of care for emergency department visits, hospitalizations, and revisit rates. Our purpose was to examine the relationships between sociodemographic variables and healthcare utilization in older adults with cognitive impairment.MethodThe Health and Retirement Study (HRS), Rand data (2014), were used to understand sociodemographic predictors of healthcare utilization (hospital stay days, nursing home days, home care days, and numbers of doctor’s visits). Due to the skewness of the data, we grouped each category for the length of healthcare utilization into never, short, medium, and long. Only those persons with dementia or impaired cognition were included.ResultOf the 3,924 older adults from the HRS sample, 22% had a diagnosis of dementia and 78% had impaired cognition. Ethnicity, education, and age were significantly associated with the length of hospital stay. Hispanics and those with lower education and younger were less likely to use long hospital stays than others. Ethnicity, marital status, gender, and age were predictors of nursing home length of stay. Blacks, Hispanics, men, and married and younger respondents were less likely to stay long in nursing homes. Blacks and younger respondents were less likely to have long home care utilization. Race, ethnicity, rurality, gender, education, and age were predictors of doctor’s visits. Blacks, Hispanics, rural residents, men, those with lower education, and younger had fewer doctor’s visits. Race, ethnicity, and education were consistent predictors across utilization types.ConclusionThis study provides evidence of the need to understand how older adults with cognitive impairments and multiple marginalized identities (i.e., age, gender, race, ethnicity) can access and use healthcare. This study is important to provide the groundwork for further studies to explore the intersectionality of healthcare utilization and socioeconomic status in patients with cognitive impairments.

Long-term Dependency in Older Adults After Surgery or Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer.

To examine long-term healthcare dependency outcomes of stereotactic body radiation therapy (SBRT) to surgery for older adults with stage I non-small cell lung cancer (NSCLC). SBRT is an emerging alternative to surgery in patients with early-stage lung cancer. There remains a paucity of prospective studies comparing these modalities, especially with respect to long-term dependency outcomes in older adults with lung cancer. Adults 70 years old and above with stage I NSCLC treated with surgery or SBRT from January 2010 to December 2017 were analyzed using 1:1 propensity score matching. Homecare use, days at home, and time spent alive and at home were compared. E-value methods assessed residual confounding. A total of 1129 and 2570 patients underwent SBRT and surgery, respectively. In all, 1016 per group were matched. SBRT was associated with a higher overall risk of homecare utilization [hazard ratio (HR)=1.75, 95% confidence interval (CI): 1.37-2.23] than surgery up to 5 years following treatment. While the hazards of death or nursing home admission were lower in the first 3 months after SBRT (HR=0.55, 95% CI: 0.36-0.85), they became consistently higher beyond this period and remained high up to 5 years compared with surgery (HR=2.13; 95% CI: 1.85-2.45). The above findings persisted in stratified analyses for frail patients and those with no pretreatment homecare. E-values indicated it was unlikely that the observed estimates could be explained by unmeasured confounders. Surgery offers robust long-term dependency outcomes compared with SBRT. These are important patient-centered endpoints which may be used for counseling and shared decision-making in older adults with stage I NSCLC.

Adequacy of Medical Home Care and Sociodemographic Factors Associated With Educational Services Use Among Children With Autism Spectrum Disorder

<h3>Research Objectives</h3> To examine whether adequacy of medical home care was significantly associated with the likelihood of children with an autism spectrum disorder (ASD) currently using educational services To identify sociodemographic factors associated with current use of educational services among children with ASD. <h3>Design</h3> Retrospective analysis of cross-sectional data from the 2016/2017 National Survey of Children's Health (NSCH). Binary logistic regression was conducted with current educational services utilization as the outcome. <h3>Setting</h3> The 2016/2017 NSCH was administered to households in the U.S. and District of Columbia. <h3>Participants</h3> Participants were 1,248 children ages 1-17 years old with ASD currently receiving educational services under individualized family service or education plans. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Educational services utilization was defined as current receipt of an individualized family or educational service plan. <h3>Results</h3> Inadequate medical home care was significantly associated with higher likelihood of current educational services use (aOR = 1.95, 95% CI [1.10, 3.44], p = .028) in children with ASD. Sociodemographic factors significantly associated with lower odds of using educational services included older children (aOR = 0.91, 95% CI [0.84, 0.99], p = .028), lower overall maternal health status (aOR = 0.52, 95% CI [0.29, 0.94], p = .031), and children who did not qualify as having special health care needs (aOR =0.38, 95% CI [0.17-0.85], p = .018). <h3>Conclusions</h3> Results suggest inadequate medical home care is associated with higher odds of educational services utilization in children with ASD. Use of educational services varies by children's age, maternal health status, and presence of other special health care needs. The inverse relationship between adequacy of medical home care and educational services utilization among children living with ASD suggests further research to explore the complex relationship between medical home care and educational services use. Future research is needed to examine differences more closely in medical home care, defined within the NSCH survey structure, in relationship to the odds of educational services utilization. <h3>Author(s) Disclosures</h3> The presenter declares no conflict of interest.

Aging, care and dependency in multimorbidity: how relationships affect elderly women’s homecare and health service use

Relationships are multidimensional, and we know little about the facets of relationships in the way elderly patients’ with multimorbidity utilise homecare and health services. Gerontology literatures emphasize the importance of place of care, inequalities, availability of health services and affordability. However, the diversity of relationships and associated dependency in elderly care remain underassessed. A qualitative study involving a demographic survey and interviews was conducted to explore relationship experiences of elderly women with multimorbidity in homecare and health services utilization. Civil Surgeon of Sylhet District in Bangladesh was contacted to recruit participants for the study, and this resulted in 33 interviews [11 staff and 22 elderly women with multimorbidity]. Three domains of Axel Honneth’s Theory of Recognition and Misrecognition [i.e. intimate, community and legal relationships] were used to underpin the study findings. Data was analysed using critical thematic discourse method. Four themes were emerged: nature of caregiving involved; intimate affairs [marital marginalization, and parent-children-in law dynamics]; alienation in peer-relationships and neighbourhood [siblings’ overlook, neighbourhood challenges, and gender inequality in interactions]; and legal connections [ignorance of rights, and missed communication]. A marginalization in family relationships, together with poor peer supports and a misrecognition from service providers, resulted in a lack of care for elderly women with multimorbidity. Understanding the complexities of elderly women’s relationships may assist in policy making with better attention to their health and well-being support needs. Staff training on building relationships, and counselling services for family and relatives are essential to improve the quality of care for the women.

Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries.

ObjectivesTo examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization.MethodsRetrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use.ResultsParticipants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91).DiscussionOur findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.

Assessment of Pediatric First Permanent Molar Management under General Anesthesia at the King Abdulaziz Medical City, Jeddah, Saudi Arabia

Background: The use of general anesthesia (GA) among children has seen an increase globally. Both tooth extraction and restoration treatments on children were done under GA, but there are consequences in using GA in children, which also include changes in the treatment plan. First permanent molar (FPM) treatment under GA is a very strategic treatment, but there is a notable lack of studies that assess in detail this type of treatment, especially its frequency of administration under GA. This study determines the treatment frequency and the type of FPM treatment in children under GA at the King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia.&#x0D; Methods: Our study is a cross-sectional study that reviewed the cases of dental rehabilitation in children between the ages of 5 and 14 years old from 2015 to 2018. These children had erupted first permanent molars and were treated under GA.&#x0D; Results: This study included 394 children, with 1330 FPMs treated under general anesthesia for (27%) preventive, (56%) restorative, and (17%) extraction treatments. The frequency of FPM treatments administered were color restoration (49%), fissure sealant application (37%), SSC (8.9%), and amalgam filling (4.5%). Low pulpal treatment was reported which was mostly involved indirect pulp capping. Most of the final restorations that were done covered only one surface, followed by the two-surface restorations, and then by SSC. &#x0D; Conclusions: The pediatric dentists’ decision for FPMs treatment under general anesthesia at KAMC was following AAPD guideline and its frequency was mostly restorative followed by preventive, and the least treatment was extraction treatments. The type of FPMs treatment administered on children was significantly influenced by their ages, gender, and health conditions. The type of tooth restoration and pulp therapy treatments were significantly dependent on children’s age. KAMC pediatric dentist efforts should be directed to initiate more preventive programs and effective dental home care utilization at PHC centers.

Determinants of home care utilization among the Swedish old: nationwide register-based study

Since the 1990s, Sweden has implemented aging-in-place policies increasing the share of older adults dependent on home care instead of residing in care homes. At the same time previous research has highlighted that individuals receive home care at a higher age than before. Consequently, services are provided for a shorter time before death, increasing reliance on family and kin as caregivers. Previous studies addressing how homecare is distributed rely primarily on small surveys and are often limited to specific regions. This study aims to ascertain how home care services are distributed regarding individual-level factors such as health status, living arrangements, availability of family, education, and socioeconomic position. To provide estimates that can be generalized to Sweden as a whole, we use register data for the entire Swedish population aged 65 + in 2016. The study's main findings are that home care recipients and the amount of care received are among the oldest old with severe co morbidities. Receiving home care is slightly more common among women, but only in the highest age groups. Childlessness and socioeconomic factors play a small role in who receives home care or not. Instead, the primary home care recipients are those older adults living alone who lack direct support from family members residing in the same household.

Aging, care and dependency in multimorbidity: how do relationships affect older Bangladeshi women’s use of homecare and health services?

ABSTRACT Gender issues can create major barriers to healthcare utilization for older women with multimorbidity, especially in developing countries like Bangladesh. Elderly rural women in Bangladesh, are the poorest of the poor, and the women with multimorbidity live in a regulated family atmosphere. This study explored the relationship dimensions of older women with multimorbidity in homecare and their utilization of health services. To gain a deeper understanding of these complex issues, a qualitative case study was conducted. Semi-structured, in-depth interviews were conducted with 11 health staff and 22 older women with multimorbidity, living in three residential communities of the Sylhet District, Bangladesh. Our analysis used critical thematic discourse, a technique developed from Axel Honneth’s recognition-and-misrecognition theory. Seven relationship dimensions have been identified, and grouped under three major themes: intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in community relationships [patriarchal sibling relationships, neighborhood challenges, and gender inequality in interactions]; and legal disconnections [ignorance of rights and missed communication]. Our findings revealed a lack of understanding of the women’s multimorbid care needs and patriarchal marginalization in family. This lack of understanding together with poor peer-supports in healthcare is perpetuated by misrecognition of needs from service providers, resulting in a lack of quality and poor utilization of homecare and health services. Understanding the high needs of multimorbidity and complexities of older women’s relationships can assist in policy decisions. This study deepens our understanding of the ways gender inequality intersects with cultural devaluation to reduce the well-being of older women in developing countries.

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review

BackgroundOlder adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to ‘age in place’ in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear.ObjectivesTo provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries.MethodsA scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies.ResultsA total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants.ConclusionThis is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform.

The Effects of Old Age Care Services and Long-Term Care Insurance: Evidence From Korea

Along with a rapidly aging population globally, the need for homecare is on the rise. Such care can be a heavy financial burden on older people and their households. To address this issue, the Korean government initiated two programs: care services for low-income individuals and voluntary long-term care insurance for people age 65+. Although it has been a decade since the implementation of the programs, there is limited evidence on how they affect the economic lives of older people, with and without disabilities. We use the 2008-2018 Korean Longitudinal Study of Aging (KLoSa) that provides detailed information about healthcare and homecare utilization and out of pocket costs for people aged 45 or older. We investigate the economic effects of old age public assistance programs using multivariate linear regression models and a dynamic panel model. The preliminary results indicate that older people with disabilities are more likely to utilize homecare services but do not experience any significant extra costs associated with homecare, implying that old age public assistance programs mitigate the financial burden of homecare for older people.

Professional home care and the objective care burden for family caregivers of persons with spinal cord injury: Cross sectional survey.

Spinal cord injury imposes high demands on family caregivers providing long-term care. Professional home care has been suggested for family caregivers' relief. However, it is not clear whether professional home care can achieve the goal of relieving family caregivers. To quantify to what extent professional home care was used as a relief or replacement for family caregivers, using the case of care for persons with spinal cord injury in Switzerland. Cross-sectional survey. Community setting in Switzerland. 717 family caregivers of persons with spinal cord injury living at home. Linear regression analyses were applied to investigate the relationship between care hours by family caregivers and the use of professional home care. Percentages of family caregivers that assisted in different tasks, and their time investment in the tasks, were contrasted between those with and without professional home care. Multiple logistic regression compared the likelihood of specific tasks being assisted by family caregivers dependent on whether professional home care was in place. The reasons given for not hiring more professional home care despite unmet needs were described with relative frequencies. Adjusted for non-utilization, care hours of family caregivers had a positive, but insignificant, relationship with the hours of professional home care (Coef.=0.21, 95% CI: -0.05-0.47). Assistance in activities of daily living was more frequent in family caregivers with professional home care. Eating and drinking assistance was provided by 47% of family caregivers with professional home care (versus 18% of those without professional home care). The most frequent task in instrumental activities of daily living was housekeeping (88% of family caregivers with professional home care and 83% of those without professional home care). After adjusting for characteristics of the caregivers and care recipients, significantly lower odds of assistance were found in washing feet (OR 0.39, 95% CI: 0.22-0.71), transferring to the toilet or bathtub (OR 0.53, 95% CI: 0.29-0.96), and climbing stairs (OR 0.26, 95% CI: 0.09-0.69). Higher odds of assistance were found in respiratory care (OR 2.22, 95% CI: 1.04-4.74) and bladder management (OR 1.99, 95% CI: 1.05-3.76) with professional home care in place. No significant difference was found in other tasks. Professional home care is a strong support to caregivers in high care demand situations, but it is not a replacement. The present study recommends further relief, empowerment, and acknowledgement for family caregivers.What is already known about the topic?• Evidence has shown that family caregivers replace paid domestic help or postpone the use of professional home care in the elderly population.• The large involvement translates into highly stressed family caregivers, for whom professional home care could serve as a relief.• Family caregivers reported low utilization of professional home care and some frustration with its use.What this paper adds• Family caregivers' time investment and involvement in tasks were adjusted based on the care demand of the care recipients.• Despite the presence of professional home care, family caregivers still invested a considerable amount of time and were heavily involved in activities of daily living.• Professional home care provided strong support for family caregivers in instances of higher care demand.

Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study

IntroductionFrailty is an important prognostic factor, and the association with postoperative dependence is important outcome to older adults. We examined the association of frailty with long-term homecare utilization for older adults following cancer surgery. MethodsIn this population-based cohort study, we determined frailty status in all older adults (≥70 years old) undergoing cancer resection (2007–2017). Outcomes were receipt of homecare and intensity of homecare (days per month) over 5 years. We estimated the adjusted association of frailty with outcomes, and assessed interaction with age. ResultsOf 82,037 patients, 6443 (7.8%) had frailty. Receipt and intensity of homecare was greater with frailty, but followed similar trajectories over 5 years between groups. Homecare receipt peaked in the first postoperative month (51.4% frailty, 43.1% no frailty), and plateaued by 1 year until 5 years (28.5% frailty, 12.8% no frailty). After 1 year, those with frailty required 4 more homecare days per month than without frailty (14 vs 10 days/month). After adjustment, frailty was associated with increased homecare receipt (hazard ratio 1.40; 95%CI 1.35–1.45), and increasing intensity each year (year 1 incidence rate ratio [IRR] 1.22, 95%CI 1.18–1.27 to year 5 IRR 1.47, 95%CI 1.35–1.59). The magnitude of the association of frailty with homecare receipt decreased with age (pinteraction <0.001). ConclusionWhile the trajectory of homecare receipt and intensity is similar between those with and without frailty, frailty is associated with increased receipt of homecare and increased intensity of homecare after cancer surgery across all age groups.

Immediate and Long-Term Health Care Support Needs of Older Adults Undergoing Cancer Surgery: A Population-Based Analysis of Postoperative Homecare Utilization.

Functional outcomes are central to decision-making by older adults (OA), but long-term risks after cancer surgery have not been described beyond 1year for this population. This study aimed to evaluate long-term health care support needs by examining homecare use after cancer surgery for OA. This population-based study investigated adults 70years of age or older with a new cancer diagnosis between 2007 and 2017 who underwent resection. The outcomes were receipt and intensity of homecare from postoperative discharge to 5years after surgery. Time-to-event analysis with competing events was used. Among 82,037 patients, homecare use was highest (43.7% of eligible patients) in postoperative month 1. The need for homecare subsequently decreased to stabilize between year 1 (13.9%) and year 5 (12.6%). Of the patients not receiving preoperative homecare, 10.9% became long-term users at year 5 after surgery. Advancing age, female sex, frailty, high-intensity surgery, more recent period of surgery, and receipt of preoperative homecare were associated with increased hazards of postoperative homecare. Intensity of homecare went from 10.3 to 10.1days per patient-month between month 1 and year 1, reaching 12days per patient-month at year 5. The type of homecare services changed from predominantly nursing care in year 1 (51.9%) to increasing personal support services from year 2 (69.6%) to year 5 (77.5%). Receipt of homecare increased long-term after cancer surgery for OA, peaking in the first 6months and plateauing thereafter at a new baseline. One tenth of the patients without preoperative homecare became long-term homecare users postoperatively, indicating changing health care needs focused on personal support services from year 2 to year 5.

Profile of Long-Term Care Recipients Receiving Home and Community-Based Services and the Factors That Influence Utilization in Taiwan.

In response to the irreversible aging trend, the Taiwan government has promoted the Long-Term Care (LTC) policy 1.0 launched in 2007 and the LTC policy 2.0 reform since 2016. This study aimed to explore the utilization of formal home and community-based care under LTC policy 1.0 to add scientific support for the on-going LTC policy 2.0 reform. Methods: By using Andersen and Aday’s behavioral model of healthcare utilization, the long-term care dataset was analyzed from 2013 to 2016. A total of 101,457 care recipients were identified after data cleaning. Results: The results revealed that about 40.7% of the care recipients stayed in the care system for more than two years. A common factor influencing the length of home and community-based services (HCBS) utilization period included need factors, where more dependent recipients leave the LTC system regardless of their socio-economic status. However, the utilization period of non-low-income households is significantly affected by the level of service resources. Conclusion: For long-term care needs, the phenomenon of a short utilization period was concerning. This study adds information which suggests policy should reconsider care capacity and quality, especially for moderate to severely dependent recipients. This will allow for better understanding to help maintain care recipients in their own communities to achieve the goal of having an aging in place policy.

Informal, formal, or both? Assessing the drivers of home care utilization in Austria using a simultaneous decision framework

ABSTRACT Understanding the relationship between different modes of home care for the elderly and the determinants of mode choice is fundamental for an efficient care policy in ageing societies. However, empirical research on this issue has revealed that policy conclusions will depend on both national and methodological factors. Using data for Austria from the Survey of Health, Ageing and Retirement in Europe, the purpose of the present paper is twofold: First, at least to our knowledge, it is the first comprehensive assessment of this kind for Austria. Second, it adds to the literature explicitly focusing on the combined use of informal and formal care in addition to the exclusive use of these services based on an econometric framework accounting for the simultaneity and interdependence between these modes. Our results provide strong evidence for a task-specific and complementary relation of formal and informal home care in Austria, with the health status and functional limitations as the main determinants of home care choice.