Substudy 5 Fact Sheet

Study of the Costs and Outcomes of Home Care and Residential Long Term Care Services (NA101-05)

Sponsor Organization:
University of Victoria and Hollander Analytical Services Ltd.

Rationale/Goals:
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.

Activities:
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.


Key Findings:
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.

Implications:
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.

Evaluation Methodology:
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 substudy.

HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)

Language of Report:
English

• Executive summary
• Full report