Substudy 6 Fact Sheet

Decision-Making: Home Care or Long-Term Care Facility (NA101-06)

Sponsor Organization:
University of Ottawa

Rationale/Goals:
This project is one of fifteen sub-studies of the National Evaluation of the Cost Effectiveness of Home Care Project (NA101). The goal of Sub-study 6 was to identify the factors that determine whether a client should be cared for through home care or in a long-term care facility, and the extent to which home care and facility care can be substituted for one another.

Activities:
This project involved collecting and analyzing data generated through focus groups, interviews and a questionnaire.

Key Findings:
The project leaders identified the following factors as indicators of whether a client should receive care in a long-term facility:

• suitability of the client's home environment;
• availability of community support or services;
• complexity of the client's care needs; and
• judgment of health care providers regarding the client's suitability for long-term care.

Factors that indicate whether a client can be cared for at home included:

• provincial policies that ensure access to, and funding for, home-care services;
• availability of family/informal caregivers;
• availability of seniors' housing which accommodates mobility problems;
• availability of regular respite care; and
• appropriateness of the client's level of independence, and the coping abilities of the family.

Project leaders also found that:

• Clients and their families need more information about their options, such as the relative costs of home care and facility care. For instance, paying for two additional half-days of home-support services can cost less than paying for care in a long-term care facility.
  
• Convalescent facilities, which can help people to regain a degree of independence and return home, are in short supply across the country.

Implications:
The project leaders indicated that their findings are important because, in their view:

• The project notes various factors that can influence a decision by clients and their families to opt for home care or a long-term facility.
• It identifies a number of organizational and systemic factors that governments and service providers must address in order to deliver more efficient and cost-effective care.
• The study offers new perspectives on the ethical issues and dilemmas that case managers face daily (such as equity and maintenance of professional standards of practice).
• Suggestions are aimed at both making cost-effective services available, and helping families choose the best care alternatives.

Evaluation Methodology:
Since home care case managers and community care coordinators facilitate the movement of clients through the continuing care system, they were the key informants in this study. Some 89 home care case managers in urban and rural sites in British Columbia, Alberta, Saskatchewan, Ontario and Prince Edward Island completed a questionnaire and participated in a focus group.

The project team interviewed senior managers involved with home care and long-term care facilities, either to verify information or to obtain more information than they were able to collect in the focus groups. The focus group data were analyzed and organized.

Resources Developed:

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

Language of Report:
English

• Executive summary
• Full report