Objectives: To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programs, Veterans’ Affairs Community Nursing (VCN) and Home Care Package (HCP).
Methods: Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans’ claims databases (2010-19) and the Registry of Senior Australians Historical Cohort (2010-17), plus aggregate program expenditure data. This involved 21636 VCN clients (20980 aged 65-100 years), and an age- and sex-matched HCP cohort (N=20980).
Results: Service factors associated with lower risk of care home admission in the VCN cohort were periodic (vs continuous) service delivery (HR 0.27 [95%CI, 0.24-0.31] for <18 months; HR 0.89 [95%CI, 0.84-0.95] for >18 months), and majority care delivered by registered nurses (vs personal care workers) (HR 0.86 [95%CI, 0.75-0.99] for <18 months; HR 0.91 [95%CI, 0.85-0.98] for >18 months). In the matched cohorts, the time to care home admission for VCN clients (median 28 months, IQR 14-42) was higher than for HCP clients (14, IQR 6-27). Within 5 years of service access, 57.6% (95%CI, 56.9-58.4) of HCP clients and 26.6% (95%CI, 26.0-27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5 years for relevant government providers was over A$1 billion.
Conclusions: Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries’ efforts to enhance community-based care services.