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5 Fact Sheet
Study of the Costs and Outcomes of Home Care and Residential Long
Term Care Services (NA101-05)
University of Victoria and Hollander Analytical Services Ltd.
This project is one of fifteen sub-studies of the National Evaluation
of the Cost-Effectiveness of Home Care Project (NA101). Sub-study 5 examined
whether it costs less to provide care in the community than in a long-term
care facility, and compared care outcomes for community clients compared
to facility clients. It also measured the informal costs of care by identifying
the psychological, social, and financial burdens shouldered by family,
friends, and volunteers looking after clients in both settings.
The study sample consisted of individuals 65 years of age or older who
were receiving long term care services either in the community or within
a care facility in two study sites (Victoria and Winnipeg). Stable clients
were randomly sampled based on their level of care, including cognitively
intact and cognitively impaired clients. The final sample size was 580,
consisting of 222 community clients and 358 facility clients. Where possible,
information was obtained regarding informal caregivers' experiences of
providing care to clients. A total of 501 caregivers participated in the
study, 184 for community clients and 317 for facility clients. (Twenty-five
caregivers did not participate, and an additional 54 clients did not have
a caregiver). Client and caregiver questionnaires were administered to
examine the impact of care on each client. In addition, diaries were used
to collect information on three elements: time and assistance provided
by formal service providers either in the community or in long term care
facilities; time and assistance provided by informal caregivers; and expenditures
related to the clients' health care needs.
The project leaders identified the following findings:
- Regardless of whether only formal care costs or both formal and informal
care costs were considered, community care was significantly less costly
than residential care. Home care costs to government were, on average,
about 40% to 50% of residential care costs. However, informal costs
were considerable. Clients and informal caregivers contributed approximately
half of the care costs of community clients and about one third of the
care costs of facility clients.
- Community clients had higher cognitive functioning than facility clients,
and cognitive functioning declined as clients' general functioning declined.
Facility clients generally felt better about their health and themselves
compared to community clients. Community and facility clients felt similarly
about their quality of life. Clients at different care levels were comparable
on the various measures.
- Caregivers of facility clients perceived that they had less objective
burden but more emotional burden than caregivers of community clients.
Caregivers' satisfaction with the services clients were receiving was
higher than clients' satisfaction with the services.
- Different jurisdictions may have different policies regarding the
delivery of health care services. For example, the cost of care increased
as the care requirements of the clients increased in the Victoria site,
a finding that is consistent with the case mix funding approach used
in British Columbia. The costs of care were relatively constant across
all care levels in the Winnipeg site, which is consistent with the funding
approach used in Manitoba.
The project leaders indicated that their findings are significant because,
in their view:
- The finding that informal costs are considerable raises a number
of policy questions: Is it reasonable for government to pay fully for
short term curative care provided by physicians and hospitals but not
pay the same proportion for people with ongoing care needs? If one can
substitute home and community services for institutional services, why
are there so few targeted programs to do so? What is an appropriate
allocation of fiscal responsibilities between the family and the state
for people requiring home- and community-based services? Should home
care and residential care be considered "health" services
or "social welfare" services?
- Differences in care provision between the two study sites indicate
that further research and clinical investigation are warranted to examine
how policy makers in all provincial and territorial jurisdictions in
Canada develop and implement policies regarding care provision.
As this project was analytic/evaluative in nature, please see the "Activities"
section. A related study (sub-study 4) developed the tools used in this
HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)
Language of Report: