Home Independence Program RCT

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
Analysis of the data from this project demonstrates clear differences between the HIP and HACC groups in terms of their Silver Chain service outcomes at three months and one year.  However, these differences in need for ongoing personal care services are not reflected by differential improvement between the groups in the sub-study in terms of dependency, confidence, quality of life scores or functional mobility.

While the first study objective has been achieved, achievement of the other four research objectives rely on the extraction and linkage of health and aged care data sets external to Silver Chain.  An application for the extraction and linkage of data was made to the Data Linkage Unit in September 2008.  Ethics approval for the extraction of the data has been granted but we are waiting on approval from the various data custodians of the different data sets before the data will be extracted and released to us.  We have had approval for the data from the WA held data sets to be released to us but are still waiting to receive it.  We will not wait for Commonwealth data to become available but will commence analysis with the state data as soon as it becomes available.

A paper presenting the one year findings from the trial was presented at the Australian Association of Gerontology Conference in November 2008 and at the World Congress of Gerontology and Geriatrics Conference in Paris in July 2009.

Publications

The Home Independence User Manual
The Home Independence User Manual describes the development of the Home Independence Program (HIP) and how it works.  The HIP Manual is currently out of print however it is intended it will be updated and reprinted in the future.  If you would like any information about the HIP Manual, please email dwoods@silverchain.org.au.

A non-randomised controlled trial of the Home Independence Program (HIP) - an Australian restorative program for older home care clients [PDF]
Lewin, G. & Vandermeulen, S. 2009. A non-randomised controlled trial of the Home Independence Program (HIP) - an Australian restorative program for older home care clients. Health and Social Care in the Community. Also available online in advance of print.

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