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. 2019;23(3):271-280.
doi: 10.1007/s12603-018-1145-y.

Prolonged Wait Time Prior to Entry to Home Care Packages Increases the Risk of Mortality and Transition to Permanent Residential Aged Care Services: Findings from the Registry of Older South Australians (ROSA)

R Visvanathan  1 , A T Amare, S Wesselingh, R Hearn, S McKechnie, J Mussared, M C Inacio
Affiliations

Prolonged Wait Time Prior to Entry to Home Care Packages Increases the Risk of Mortality and Transition to Permanent Residential Aged Care Services: Findings from the Registry of Older South Australians (ROSA)

R Visvanathan et al. J Nutr Health Aging. 2019.

Abstract

Background: Older Australians prefer to live in their own homes for longer and reforms have attempted to increase the volume of home care packages (HCPs) accordingly but there remains a queue with the longer-term consequences unclear.

Objectives: This study aims to characterise older Australians according to their wait times for a home care package (HCP), evaluate the association between wait time and mortality and evaluate the association between wait time and transition to permanent residential aged care services after HCP.

Design: A retrospective cohort study using data from the National Historical cohort (2003-2014) of the Registry of Older South Australians (ROSA) was conducted.

Setting: Home based aged care services, national cohort.

Methods: Wait time was estimated from approval date to date of receiving a HCP. Descriptive, survival estimates (95% confidence intervals (CIs)), and multivariable survival analyses (Cox-regression) were conducted to evaluate the risk of mortality and transition to permanent residential aged care services by quartiles of wait time for HCP.

Results: The cohort was followed for 4.0 years (interquartile range IQR (1.8-7.2)) and 38% were alive at the end of the study period with a median wait time for HCP of 62 (21-187) days. From 178,924 older people who received a HCP during the study period (2003-2013), 33.2% people received HCP within 30 days, 74.3% within 6 months and 25.7% after 6 months. The effect of wait time on risk of mortality was time-dependent, with longer wait times associated with higher mortality in the longer term. Compared to people who waited ≤30 days for a HCP, individuals who waited more than 6 months had an almost 20% excess risk of death (adjusted hazard ratio (aHR), 95%CI = (1.18, 1.16-1.21)) 2 years after entry into a HCP. Those who waited more than 6 months also had a 10% (1.10, 1.06-1.13) higher risk of transition to permanent residential aged care services after two years.

Conclusion: Prolonged wait times for HCP is associated with a higher risk of long-term mortality as well as transition to permanent residential aged care. It remains to be seen if a shortening of this wait time translates into better health outcomes.

Keywords: Healthy ageing; aged care; mortality; nursing home; wait time.

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Conflict of interest statement

Mr Richard Hearn is the Chief Executive Officer, Ms Sue McKechnie is the Executive Manager Community Services and Professor Renuka Visvanathan is a Board Member of Resthaven Inc., a not for profit aged care community service associated with the Uniting Church in Australia but separately incorporated, financially independent and a charitable Public Benevolent Institution. Ms Jane Mussared is the Chief Executive Officer of Council on the Ageing South Australia, a peak body for 630,000 older people in South Australia providing a platform to ensure that older South Australians are part of the decision-making by government and industry.

Figures

Figure 1a
Figure 1a
Cumulative survival probability after accessing a home care package by wait time
Figure 1b
Figure 1b
Cumulative survival probability after entry into permanent residential aged care services by wait time for home care packages
Figure 2
Figure 2
Cumulative incidence of transition into permanent residential aged care services by wait time for home care packages
See this image and copyright information in PMC

References

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