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Seniors at Risk: The Association between the Six-Month Use of Publicly Funded Home Support Services and Quality of Life and Use of Health Services for Older People*

Published online by Cambridge University Press:  31 March 2010

M. Markle-Reid ,
G. Browne ,
R. Weir ,
A. Gafni ,
J. Roberts  and
S. Henderson
M. Markle-Reid*
Affiliation:
School of Nursing McMaster University
G. Browne
Affiliation:
School of Nursing McMaster University Ontario Training Centre in Health Services and Policy Research
R. Weir
Affiliation:
Faculty of Health Science, McMaster University
A. Gafni
Affiliation:
Health Economics, McMaster University
J. Roberts
Affiliation:
Faculty of Health Science, McMaster University
S. Henderson
Affiliation:
School of Nursing McMaster University
*
Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Dr. Maureen Markle-Reid, McMaster University, School of Nursing, 1200 Main Street West, HSC 3N28H, Hamilton, ON L8N 3Z5, (mreid@mcmaster.ca)
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Abstract

This study examines the baseline characteristics and changes in health status and cost of use of health services associated with use of publicly funded home support services. The analysis includes 122 people 75 years of age or more who were eligible for home support services. Over a 6-month period, one third of the sample used home support services for more than 1hr/week; these seniors had higher rates of depression and cognitive impairment, lower levels of physical and emotional functioning, and less effective coping styles than those who used fewer services. Cognitive impairment explained 17 per cent of the variation in use of home support services. At 6 months, use of home support services for more than 1hr/week by seniors with higher levels of need was associated with lower cost of use of health services and lower levels of improvement in health status. These findings suggest the need for further research to identify efficacious ways of providing home support services to this population to enhance their health status using available resources.

Résumé

La présente étude évalue les caractéristiques de base et les changements dans l'état de santé et le coût des services de soins de santé utilisés en association avec les services de soutien à domicile subventionnés par l'État. l'analyse comprend 122 personnes de ≥75ans admissibles aux services de soutien à domicile. Au cours d’une période de six mois, un tiers des personnes faisant partie de l'échantillon ont utilisé des services de soutien à domicile pendant ≥1 heure par semaine. Le taux de dépression et de déficience cognitive, le degré réduit de fonctionnement physique et émotionnel, et une capacité d’adaptation moins efficace étaient plus élevés chez ces aînés que chez ceux qui utilisaient moins de services. La déficience cognitive a expliqué 17 pour cent de la variation dans l'utilisation des services de soutien à domicile. Pour la période de six mois, l'utilisation de services de soutien à domicile pendant ≥1 heure par semaine par des aînés ayant des besoins plus importants était associée à un coût plus faible d’utilisation pour les services de soins de santé et à un niveau d’amélioration plus faible de l'état de santé. Ces résultats suggèrent qu’il faut accélérer la recherche visant à déterminer des méthodes plus efficaces pour la prestation des services de soutien à domicile à ces personnes afin d’améliorer leur état de santé à l'aide des ressources disponibles.

Keywords

vieillissementpersonnes âgéessoins à domicileservices d’aide familialemaladie chroniqueefficacité cliniquecoûtagingelderlyhome carehomemaker serviceschronic illnessclinical effectivenesscosts
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 27 , Issue 2 , Summer/Été 2008 , pp. 207 - 224
Copyright
Copyright © Canadian Association on Gerontology 2008

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Footnotes

*

We are grateful to the following agencies for funding this project: Canadian Health Services Research Foundation, Ontario Ministry of Health and Long-Term Care, Community Care Access Centre of Halton, and McMaster University System-Linked Research Unit on Health and Social Services Utilization. Maureen Markle-Reid is a Career Scientist, Ontario Ministry of Health and Long-Term Care, Health Research Personnel Development Fund. This research was possible through the ongoing support of the Community Care Access Centre of Halton, Halton Victorian Order of Nurses, Para-Med Home Health Care, and the Halton Canadian Red Cross Homemakers. We are also grateful to the following individuals: Maria Wong and May Wong (data analysis), Karen Auld (project coordination), and Leah Macdonald (data entry).

References

Anderson, M., & Parent, K. (2000). Care in the home—Public responsibility: Private role. Kingston, ON: Department of Rehabilitation Medicine, Queen's University.Google Scholar
Aronson, J., & Neysmith, S.M. (1996). The work of visiting homemakers in the context of cost cutting in long-term care. Canadian Journal of Public Health, 87, 422–425.Google ScholarPubMed
Bergman, H.F., Beland, P., Lebel, A.P., Contandriopoulos, P., Tousignant, Y., Brunelle, T., et al. (1997). Care for Canada's frail elderly population: Fragmentation or integration? Canadian Medical Association Journal, 157, 1116–1121.Google ScholarPubMed
Birch, S., & Gafni, A. (2003). Economics and the evaluation of health care programmes: Generalizability of methods and implications for generalizability of results. Health Policy, 64, 207–219.CrossRefGoogle ScholarPubMed
Browne, G., Arpin, K., Corey, P., Fitch, M., & Gafni, A. (1990). Individual correlates of health service utilization and the costs of poor adjustment to chronic illness. Medical Care, 28(1), 43–58.CrossRefGoogle ScholarPubMed
Browne, G., Gafni, A., Roberts, J., Whittaker, S., Wong, M., & Prica, M. (2001). Approach to the measurement of costs (expenditures) when evaluating health and social programs. (Working Paper Series 01–03). System-Linked Research Unit on Health and Social Service Utilization, McMaster University.Google Scholar
Browne, G., Roberts, J., Byrne, C., Gafni, A., Weir, R., & Majumdar, B. (2001). The costs and effects of addressing the needs of vulnerable populations: Results of 10 years of research. Canadian Journal of Nursing Research, 33, 65–76.Google ScholarPubMed
Browne, G., Roberts, J., Gafni, A., Byrne, C., Weir, R., Majumdar, B., & Watt, S. (1999). Economic evaluations of community-based care: Lessons from twelve studies in Ontario. Journal of Evaluation in Clinical Practice, 5, 1–19.CrossRefGoogle ScholarPubMed
Canadian Home Care Association (2004). Home care: A national health priority—Visionary leadership can make it happen. Ottawa: Author.Google Scholar
Canadian Home Care Human Resources Study. (Technical Report). (2003). Ottawa.Google Scholar
Canadian Nurses Association (1998). National home and community care for Canadians. Ottawa: Author.Google Scholar
Canadian Nurses Association (2006, April). Unregulated health workers: The Canadian and Global Perspective—A discussion paper. Ottawa: Author.Google Scholar
Caplan, E. (2006). Realizing the potential of home care: Competing for excellence by rewarding results. Toronto: Ontario Ministry of Health and Long-Term Care. Retrieved 8 June 2007 from http://www.health.gov.on.ca/english/public/pub/ministry_reports/ccac_05/ccac_05.pdf.Google Scholar
Carrière, G. (2006). Seniors' use of home care. Health Reports, 17(4), 43–47. (Statistics Canada, Catalogue 82–003).Google ScholarPubMed
Chappell, N.L. (2000). Maintaining the integrity of home care. Healthcare Papers, 1(4), 91–95.CrossRefGoogle ScholarPubMed
Charney, D.S., Reynolds, C.F., Lewis, L., Lebowitz, B.D., Sunderland, T., Alexopoulos, G.S., et al. (2003). Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life. Archives of General Psychiatry, 60, 664–672.CrossRefGoogle ScholarPubMed
Clatney, L. (2001/2002). Conclusive evidence elusive for PHC. (Background Paper No. 5) Saskatoon, SK: Health Services Utilization and Research Commission.Google Scholar
Cohen, M., McLaren, A., Sharman, Z., Murray, S., Hughes, M., & Ostry, A. (2006). From support to isolation: The high cost of BC's declining home support services. Vancouver, BC: Canadian Centre for Policy Alternatives Office.Google Scholar
Commission on the Future of Health Care in Canada (2002). Discussion paper: Homecare in Canada. Ottawa: Author.Google Scholar
Contandriopoulos, A., Tessier, G., & Larouche, D. (1986). The effects of Quebec home aid services on the utilization profile of sociosanitory resources: A substitution study. Social Science and Medicine, 22(7), 731–736.CrossRefGoogle ScholarPubMed
Corcoran, K., & Fisher, J. (1987). Measures for clinical practice: A source book. New York: Free Press.Google Scholar
Coyte, P.C., & McKeever, P. (2001). Home care in Canada: Passing the buck. Canadian Journal of Nursing Research, 33(2), 11–25.Google ScholarPubMed
Coyte, P.C., & Wickremaarchi, S. (2004). Blueprint for comprehensive primary health care reform in Ontario. Toronto: University of Toronto.Google Scholar
Coyte, P.C., & Young, W. (1999). Regional variations in the use of home care services in Ontario, 1993/95. Canadian Medical Association Journal, 161(4), 376–380.Google ScholarPubMed
Davidson, H., Feldman, P.H., & Crawford, S. (1994). Measuring depressive symptoms in the frail elderly. Journal of Gerontology, 49(4), 159–164.CrossRefGoogle ScholarPubMed
Deber, R. (2000). Getting what we pay for: Myths and realities about financing Canada's health care system. Background paper prepared for Dialogue on Health Reform: Sustaining Confidence in Canada's Health Care System. Toronto: University of Toronto.Google Scholar
Drummond, M.F., O'Brien, B., Stoddart, G.L., & Torrance, G.W. (1997). Methods for the economic evaluation of health care programmes. (2nd ed.). Toronto: Oxford University Press.Google Scholar
Ely, M., Brayne, C., Huppert, F.A., O'Connor, D.W., & Pollitt, P.A. (1997). Cognitive impairment: A challenge for community care—A comparison of the domiciliary service receipt of cognitively impaired and equally dependent physically impaired elderly women. Age and Ageing, 26(4), 301–308.CrossRefGoogle ScholarPubMed
Fassbender, K. (2000). An economic evaluation of home care as an alternative to institutionalization. (Working Paper No. 00–6). Edmonton, AB: Departments of Public Health Sciences, University of Alberta, Institute of Health Economics.Google Scholar
Federal, Provincial, and Territorial Advisory Committee on Population Health (1994). Investing in the health of Canadians. Meeting of the Ministers of Health Strategies for Population Health, September 14–15. Ottawa: Health Canada.Google Scholar
Forbes, D.A., Stewart, N., Morgan, D., Anderson, M., Parent, K., & Janzen, B. (2003). Individual determinants of home-care nursing and housework assistance. Canadian Journal of Nursing Research, 35(4), 14–36.Google ScholarPubMed
Health Canada (2003). 2003 First ministers' accord on health care renewal. Retrieved 8 June 2007 from http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2003accord/index_e.html.Google Scholar
Health Services Utilization and Research Commission (1996). The cost-effectiveness of home care: A rigorous review of the literature. Saskatoon, SK: Author.Google Scholar
Health Services Utilization and Research Commission (2000). The impact of preventive home care and seniors housing on health outcomes. Saskatoon, SK: Author.Google Scholar
Himmelfarb, S., & Murrell, S.A. (1983). Reliability and validity of five mental health scales in older persons. Journal of Gerontology, 38, 333–339.CrossRefGoogle ScholarPubMed
Hollander, M.J. (2003). Unfinished business: The case for chronic home care services, a policy paper. Victoria, BC: Hollander Analytical.Google Scholar
Hollander, M.J., & Tessaro, A. (2001). Evaluation of the maintenance and preventive model of home care. Ottawa: Health Canada, Home Care/Pharmaceuticals Division, Policy and Communications Branch.Google Scholar
Illife, S., Haynes, A., Gallivan, S., Booroff, A., Goldenberg, E., & Morgan, P. (1993). Assessment of elderly people in general practice, 4: Depression, functional ability and contact with services. British Journal of General Practice, 43, 371–374.Google Scholar
Irwin, M., Artin, K.H., & Oxman, M.N. (1999). Screening for depression in the older adult: Criterion validity of the 10-item Centre for Epidemiological Studies depression scale (CES-D). Archives of Internal Medicine, 159, 1701–1704.CrossRefGoogle ScholarPubMed
Johri, M., Beland, F., & Bergman, H. (2003). International experiments in integrated care for the elderly: A synthesis of the evidence. International Journal of Geriatric Psychiatry, 18, 222–235.CrossRefGoogle ScholarPubMed
Katz, I-R. (1996). On the inseparability of mental and physical health in aged persons: Lessons from depression and medical co-morbidity. American Journal of Geriatric Psychiatry, 4, 1–16.Google Scholar
Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-IIIR psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51(1), 8–19.CrossRefGoogle Scholar
Kirby, M.J.L., & LeBreton, M. (2002). The health of Canadians, The federal role: Final report—Vol 6. Recommendations for reform. Ottawa: Standing Senate Committee on Social Affairs, Science and Technology.Google Scholar
Lafrenière, S.A., Carrière, Y., Martel, L., & Bélanger, A. (2003). Dependent seniors at home: Formal and informal help. Health Reports, 14(4), 31–40.Google ScholarPubMed
LaPlante, M.P., Kaye, H.S., Kang, T., & Harrington, C. (2004). Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences. Journals of Gerontology. Series B, Social Sciences, 59(2), S98–S108.Google ScholarPubMed
Lyness, J.M., Noel, T.K., Cox, C., King, D.A., Conwell, Y., & Caine, E.D. (1997). Screening for depression in elderly primary care patients: A comparison of the Centre for Epidemiological Studies depression scale and the geriatric depression scale. Archives of Internal Medicine, 157, 449–454.CrossRefGoogle ScholarPubMed
MacAdam, M. (2000). Home care: It's time for a Canadian model. Hospital Quarterly and Healthcare Papers, 1(4), 9–36.CrossRefGoogle ScholarPubMed
Markle-Reid, M., Weir, R., Browne, G., Roberts, J., Gafni, A., & Henderson, S. (2006). Health promotion for frail older home care clients. Journal of Advanced Nursing, 54(3), 381–395.CrossRefGoogle ScholarPubMed
Martin-Matthews, A. (2002). Seniors' health. Retrieved 6 June 2007 from http://www.hc-sc.gc.ca.Google Scholar
McHorney, C.A., Ware, J.E. Jr, Lu, J.F., & Sherbourne, C.D. (1994). The MOS 36 item short-form survey, 3: Tests of data quality, scaling assumptions and reliability across diverse patient groups. Medical Care, 32(1), 40–66.CrossRefGoogle ScholarPubMed
McHorney, C.A., Ware, J.E. Jr, & Raczek, A.E. (1993). The MOS 36 item short-form health survey, II: Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31(3), 247–263.CrossRefGoogle ScholarPubMed
McWilliam, C.L., Stewart, M., Brown, J.B., McNair, S., Desai, K., Patterson, M.L., et al. (1997). Creating empowering meaning: An interactive process of promoting health with chronically ill older Canadians. Health Promotion International, 12, 111–123.CrossRefGoogle Scholar
Moos, R.H., Cronkite, R.C., Billings, A.G., & Finney, J.W. (1985). Health and daily living form manual. Palo Alto, CA: Stanford University Medical Centers.Google Scholar
Motiwala, S.S., Flood, C.M., Coyte, P.C., & Laporte, A. (2005). The first ministers' accord on health renewal and the future of home care in Canada. Longwoods Review, 2(4), 2–9.Google Scholar
National Institute of Mental Health (2003). Older adults: Depression and suicide facts. Retrieved 8 June 2007 from http://www.nimh.nih.gov/publicat/elderlydepsuicide.cfm.Google Scholar
Ontario Association of Community Care Access Centres (2003, December). Mental health services: Discussion paper. Unpublished manuscript. (Available from author).Google Scholar
Ontario Ministry of Health and Long-Term Care (1998). Long-term care act. Toronto: Queen's Printer for Ontario.Google Scholar
Ontario Ministry of Health and Long-Term Care (2004). 2003/04 Ontario hospital interprovincial per diem rates for inpatient services. Retrieved 8 June 2007 from http://www.health.gov.on.ca/english/providers/program/ohip/bulletins/na_21/bulna21_2.pdf.Google Scholar
Ontario Ministry of Health and Long-Term Care (2007). 2007/08 Ontario hospital interprovincial per diem rates for inpatient services. Retrieved 8 June 2007 from http://www.health.gov.on.ca/english/providers/program/ohip/bulletins/na_21/bulna21_2.pdf.Google Scholar
Parent, K.M., Anderson, M., & Keresztes, C. (1999). A study of the Kingston, Frontenac, Lennox, and Addington Community Care Access Centre policy to reduce home support services. Kingston, ON: Queen's University.Google Scholar
Parent, K., Anderson, M., & Neuwelt, B. (2000). Home care and people with psychiatric disabilities: Needs and issues. Toronto: Queen's University, Department of Rehabilitation Medicine and Canadian Mental Health Association, National Office.Google Scholar
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23, 433–441.CrossRefGoogle Scholar
Préville, M., Coté, G., Boyer, R., & Hébert, R. (2004). Detection of depression and anxiety disorders by home care nurses. Aging and Mental Health, 8(5), 400–409.CrossRefGoogle ScholarPubMed
Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
Roberts, J., Browne, G., Streiner, D., Gafni, A., Pallister, R., & Hoxby, H. (1995). The effectiveness and efficiency of health care promotion in specialty clinic care. Medical Care, 33(9), 892–905.CrossRefGoogle ScholarPubMed
Roberts, R.E., Kaplan, G.A., Shema, S.J., & Strawbridge, W.J. (1997). Prevalence and correlates of depression in an aging cohort: The Alemeda county study. Journals of Gerontology. Series B, Social Sciences, 52(5), S252–S258.Google Scholar
Rockwood, K., Fox, R.A., Stolee, P., Robertson, D., & Beattie, L. (1994). Frailty in elderly people: An evolving concept. Canadian Medical Association Journal, 150, 489–495.Google ScholarPubMed
Roelands, M., Van Oyen, H., Depoorter, A., Baro, F., & Van Oost, P. (2003). Are cognitive impairment and depressive mood associated with increased service utilization in community-dwelling elderly people? Health and Social Care in the Community, 11(1), 1–9.CrossRefGoogle ScholarPubMed
Romanow, R.J. (2002, November). Building on values: The future of health care in Canada—Final report. Ottawa: National Library of Canada.Google Scholar
Roos, N., Stranc, L., Peterson, S., Mitchell, L., Bogdanovic, B., & Shapiro, E. (2001). A look at home care in Manitoba. Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation.Google Scholar
Roterman, M. (2006). Seniors' health care use. Health Reports, 16(Suppl), 33–45.Google Scholar
Santor, D.A., Zuroff, D.C., Ramsay, J.O., Cervantes, P., & Palacios, J. (1995). Examining scale discriminability in the BDI and the CES-D as a function of depressive severity. Psychological Assessment, 7, 131–139.CrossRefGoogle Scholar
Schein, R.L., & Koenig, H.G. (1997). The Center for Epidemiological Studies depression (CES-D) scale: Assessment of depression in the medically ill elderly. International Journal of Geriatric Psychiatry, 12(4), 436–446.3.0.CO;2-M>CrossRefGoogle Scholar
Scott, V., Bawa, H., Votova, K., Rajabali, F., Han, G., Swan, L., et al. (2006). Strategies and action for independent living (SAIL) 2: The effectiveness of a multifaceted prevention program for the reduction of falls and injury among home support clients. Vancouver, BC: British Columbia Injury Research and Prevention Unit.Google Scholar
Soderstrom, L., Tousignant, P., & Kaufman, T. (1999). The health and cost effects of substituting home care for inpatient acute care: A review of the evidence. Canadian Medical Association Journal, 160(8), 1151–1155.Google ScholarPubMed
Stobert, S., & Cranswick, K. (2004). Looking after seniors: Who does what for whom? Canadian Social Trends, 74, 2–6.Google Scholar
Stuck, A.E., Walthert, J.M., Nikolaus, T., Bula, C.J., Hohman, C., & Beck, J.C. (1999). Risk factors for functional status decline in community-living elderly people: A systematic literature review. Social Science and Medicine, 48, 445–469.CrossRefGoogle ScholarPubMed
Temkin-Greener, H., Barjorska, A., Peterson, D.R., Kunitz, S.J., Gross, D., Williams, F., et al. (2004). Social support and risk-adjusted mortality in a frail older population. Medical Care, 42(8), 779–788.CrossRefGoogle Scholar
Council on Aging of Ottawa (2002, April). Care in the home: Challenges and opportunities. Retrieved 8 June 2007 from http://www.coaottawa.ca/library/publications/careinhome.PDF.Google Scholar
Ware, J.E., & Gandek, B. (1998). Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of Clinical Epidemiology, 51(11), 903–912.CrossRefGoogle ScholarPubMed
Ware, J.E., & Kosinski, M. (2001). SF-36 physical and mental health summary scales: A manual for users of version 1. (2nd ed.). Lincoln, RI: Quality Metric.Google Scholar
Ware, J.E., Kosinski, M., & Dewey, J.E. (2000). How to score version 2 of the SF-36 health survey (Standard and acute forms). (2nd ed.). Lincoln, RI: Quality Metric.Google Scholar
Weinert, C., & Brandt, P. (1987). Measuring social support with the PRQ. Western Journal of Nursing Research, 9, 589–602.CrossRefGoogle Scholar
Wilkins, K. (2006). Predictors of death in seniors. Health Reports, 16(Suppl), 57–67.Google ScholarPubMed
World Health Organisation (2005). Preparing a health care workforce for the 21st century: The challenge of chronic conditions. Retrieved 1 Mar. 2005 from http://www.who.int/chronic_conditions/workforce_report/en/.Google Scholar