1. Long Term Outcomes
of Restorative Home Care
Gill Lewin, Janine Alan, Helman Alfonso IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

2. Restorative Home Care Programs
 Aim to maximise independence, self esteem and quality of
life and reduce care required
 Key elements:
• Comprehensive assessment
• Goal setting
• Individualised care plans
• Targeted evidence-based interventions
• Often time limited
• May be directed to specific target groups
Restorative Home Care Long Term Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

3. Silver Chain
WA
 West Australian
 Community Health and Aged Care Provider
 40,000 + clients annually
 Many health and home support services
 ~ 45% of Govt. funded home care in WA
 In 1999 had waitlists for home care services
 Developed Restorative Home Care programs, HIP + PEP
 HIP + PEP available across Perth since 2002
Restorative Home Care Long Term Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

4. Silver Chain’s Restorative Programs
 Home Independence Program (HIP)
• Older individuals needing homecare
• Community based referral
• 12 weeks maximum
 Personal Enablement Program (PEP)
• Leaving hospital, potential to improve
• Hospital referral (may include post acute nursing)
• 8 weeks maximum
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

5. Study Objectives
 Primary objective:
Compare aged care service use over 5 yrs of individuals who
participated in HIP / PEP with that of individuals who received HACC.
 Secondary objectives:
Examine the impact of participating in an independence program, as
compared to receiving usual home care services, on delaying the need for
recommendation into residential care, improving survival and reducing care
costs over time.
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

6. Study Design and Method
 Retrospective Cohort Study
 65+ yr old HIP, PEP and HACC clients
 Referred for service 1 Jan 2004 – 31 Dec 2008
 No diagnosis of dementia
 2004-2009 client data from Silver Chain Comcare, HACC MDS, ACAP
database and mortality register linked
 Service use examined at 12, 24,36, 48 and 60 months
 Poisson regression to identify predictors of service use
 Cox regression to compare ACAT assessment or death
 Quantile regression to compare costs between groups
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

7. Results - Demographics
Control PEP HIP
N=2,332 5,450 2,586
Older than 78y 71.6% 49.3% 59.8%
Females 63.4 74.3 78.3
Need carer 26.8 64.6 57.7
Living with others 39.6 60.3 58.5
Previous HAAC 58.1 44.6 48.0
Dependence low 25.5 22.2 19.3
Dependence mod 34.9 44.1 42.7
Dependence high 35.4 6.1 9.6
0 1 2 3 4 5 6 7 8 9 10 11 120.00 0.50 1.00 1.50 2.00
TITLE Prevalence Ratio
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

8. Results – HACC All Service Use
100
Control PEP
HIP
80
*Adjusted for age,
sex, living
arrangement, having
carer, dependence
60
level and requiring
PC service previous
start study
40
20
0 12 24 36 48 60
Months of follow up
Control, n(%) 2002 (90.9) 1068 (65.8) 518 (50.2) 244 (39.2) 111 (33.0) 26 (34.2)
PEP, n(%) 3813 (71.8) 2031 (44.3) 1323 (40.8) 782 (38.5) 382 (37.8) 127 (41.5)
HIP, n(%) 1878 (75.2) 1068 (48.2) 694 (42.8) 428 (40.8) 224 (41.0) 70 (46.7)
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

9. Results – HACC Personal Care Use
100
Control PEP
HIP
80
*Adjusted for age, sex,
living arrangement,
having carer,
60
dependence level and
requiring PC service
previous start study
40
20
0
0 12 24 36 48 60
Months of follow up
Control, n(%) 1886 (85.6) 877 (54.0) 403 (39.1) 183 (29.4) 81 (24.1) 19 (25.0)
PEP, n(%) 1300 (24.5) 336 (7.3) 189 (5.8) 129 (6.4) 58 (5.7) 10 (3.3)
HIP, n(%) 825 (33.0) 224 (10.1) 131 (8.1) 68 (6.5) 34 (6.2) 3 (2.0)
Restorative Home Care Outcomes 26.10.2011
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

10. Results – ACAT assessment over time
Year acap Control PEP HIP outcome level Control PEP HIP
N=2,332 N=5,450 N=2,586 N=2,332 N=5,450 N=2,586
2004
14 (0.60) 10 (0.18) 7 (0.27) appcomm 1
2005 91 (3.90) 176 (3.23) 87 (3.36)
24 (1.03) 27 (0.50) 12 (0.46) appeach 1
2006 27 (1.16) 22 (0.40) 13 (0.50)
30 (1.29) 54 (0.99) 22 (0.85) appother 1
2007 99 (4.25) 204 (3.74) 94 (3.63)
35 (1.50) 78 (1.43) 42 (1.62)
appresi 1
2008
31 (1.33) 68 (1.25) 24 (0.93) 86 (3.69) 160 (2.94) 75 (2.90)
2009 appresi 2
13 (0.56) 19 (0.35) 18 (0.70)
Total
147 (6.30) 256 (4.70) 125 (4.83) 29 (1.24) 20 (0.37) 13 (0.50)
group Crude OR Adjusted* OR (95% CI)
(95% CI) *Adjusted for age, sex, living arrangement, having
carer, dependence level and requiring PC service
previous start study , using Cox regression
PEP
0.64 (0.52-0.79) 0.96 (0.75-1.22)
HIP
0.65 (0.51-0.82) 0.91 (0.69-1.19)
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

11. Results – Risk of death
1.5
Control PEP
HIP
group Crude OR Adjusted* OR
Cumulative Mortality Rate
(95% CI) (95% CI)
1
PEP
0.39 (0.36-0.42) 0.52 (0.47-0.57)
HIP
0.45 (0.41-0.50) 0.58 (0.52-0.65)
.5
*Adjusted for age, sex, living arrangement,
having carer, dependence level and
requiring PC service previous start study ,
using Cox regression
0
0 2 4 6
Years of follow up
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

12. Results – Adjusted Median Cumulative Costs
*Adjusted for age, sex,
living arrangement,
having carer,
dependence level and
requiring PC service
previous start study
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

13. Returns on Investment
*Adjusted for age,
sex, living
arrangement, having
carer, dependence
level and requiring PC
service previous start
study
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

14. Conclusions
Individuals who receive a restorative home care
service rather than usual HACC home care:
 have a reduced likelihood of subsequently using:
- any home care service for three years
- a personal care service for five years
 are somewhat less likely to be ACAT assessed
within the next 5 years and much less likely to be
approved for nursing home high level care
 are less likely to die over the next 5 years
 represent a much better return on investment
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J

15. Contact for more information:
g.lewin@curtin.edu.au
Restorative Home Care Outcomes IFA May 2012
Curtin University is a trademark of Curtin University of Technology
CRICOS Provider Code 00301J