Funding Body

Australian Health Ministers’ Advisory Council (AHMAC) Priority Driven Research Program ($497,827 over 5 years).

Project Description

This project aims to determine whether a new paradigm for providing home care services achieves better outcomes and is more cost effective than home care as currently provided. The new paradigm is based on the premise that early intervention to optimise functioning and promote healthy ageing can delay or prevent the development of further disability and reduce the subsequent need for home care and other aged care and health services. The new paradigm is operationalised within a service model in which older individuals referred and assessed as eligible for Home and Community Care (HACC) funded home care, are referred to the Home Independence Program (HIP) prior to being provided with “standard” HACC support and maintenance services if they still require them.

The specific objectives of the study are to:

• Compare the outcomes for older individuals who on referral to Silver Chain for home care services receive HIP, with those for individuals who receive “standard” HACC home care only.
• Determine whether the aged care careers (both community based and residential) of the individuals in the two groups are markedly different.
• Compare the costs of aged care, in both the short and longer tem, for these two groups of individuals.
• Compare the use and costs of hospital and other health services by the two groups over time.
• Compare the total health and aged-care costs of the two groups over time.

The study has been designed as a Randomised Controlled Trial (RCT) in which 1,250 individuals referred for HACC funded personal care in the metropolitan area, and who meet the study inclusion criteria, will be randomly assigned to receive either “standard” HACC services or to receive HIP (for 3 months maximum after which they will receive ongoing HACC services, if they need them). The outcomes will then be examined, using the WA linked database system, for all individuals entering the trial, over the next three years.

In addition 250 clients from each of the study groups are being recruited into a sub-study in which individuals will be visited in their own homes on four occasions over two years in order to collect functional and quality of life outcome data.

Project Update

Recruitment into the trial was completed in August 2007 with 375 clients who were referred for personal care having been randomised to each of HIP and HACC ie. there are 750 clients in total in the trial.  In addition, 300 clients, 150 HIP and 150 HACC have been recruited into the subgroups who are being visited at home to collect the detailed outcome data.

Analysis of the baseline data, a preliminary and now final analysis of the three month follow up data has been completed.  The analyses completed to date demonstrate clear differences between the HIP and HACC groups in terms of their service outcomes at three months.  When analysed according to “intention to treat’ ie. in the groups to which individuals were randomised, 20% of the HACC group and 57% of the HIP group still living in the community did not require a personal care service.  When analysed according to the actual service received, the difference was even larger with 15% of HACC and 66% of HIP no longer needing a PC service. Somewhat surprisingly however, these differences in service need are not reflected by differential improvement between the groups in terms of dependency, confidence, quality of life scores or functional mobility. 

A paper describing the preliminary findings was presented at the Australian Association of Gerontology national conference in Adelaide in November 2007.  A paper describing the complete 3 month follow up analysis was also presented by Gill Lewin as a keynote address at the First National Community Care Conference in Sydney in May 2008. 

Additionally, data from the RCT was used as the bases of two workshops – “Outcome Measurement in Silver Chain’s Independence Programs” and “Targeting the Home Independence Program” given at the HACC National Forum on Programs to Promote Independence in February.  The latter paper was also based on the findings of focus groups with the Independence Team Care Managers which were designed to help us understand how they decided in the RCT that individuals did not have the capacity to improve and were therefore not appropriate for HIP.

Publications

The Home Independence User Manual
The Home Independence User Manual describes the development of the Home Independence Program (HIP) and how it works.

Programs to Promote Independence at Home, September 2006 [PDF]
Lewin, G., Vandermeulen, S., Coster, C. 2006.  Programs to promote independence at home.  Generations Review - Journal of the British Society of Gerontology. 16(3): 24-26.

For further information please contact
Kristen De San Miguel
Research Officer
Email KDeSanMiguel@silverchain.org.au