Changes in home care clients' characteristics and home care in five European countries from 2001 to 2014: comparison based on InterRAI - Home Care data

Abstract

Background: Policymakers advocate extended residence in private homes as people age, rather than relocation to long-term care facilities. Consequently, it is expected that older people living in their own homes will be frailer and have more complex health problems over time. Therefore, community care for aging people is becoming increasingly important to facilitate prevention of decline in physical and cognitive abilities and unnecessary hospital admission and transfer to a nursing home. The aim of this study was to examine changes in the characteristic of home care clients and home care provided in five European countries between 2001 and 2014 and to explore whether home care clients who are most in need of care receive the care required.

Methods: This descriptive study used data from two European research projects, Aged in Home Care (AdHOC; 2001-2002) and Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care (IBenC; 2014-2016). In both projects, the InterRAI-Home Care assessment tool was used to assess a random sample of home care clients 65 years and older in five European countries. These data facilitate a comparison of physical and cognitive health and the provided home care between countries and study periods.

Results: In most participating countries, both cognitive (measured on the Cognitive Performance Scale) and functional ability (measured on the Activities of Daily Living Hierarchy scale) of home care clients deteriorated over a 10-year period. Home care provided increased between the studies. Home care clients who scored high on the physical and cognitive scales also received home care for a significantly higher duration than those who scored low.

Conclusion: Older people in several European countries remain living in their own homes despite deteriorating physical and cognitive skills. Home care services to this group have increased. This indicates that the government policy of long-term residence at own home among older people, even in increased frailty, has been realised.

Keywords: AdHOC; Elderly; Formal care; Health care policy; Home care; IBenC; interRAI-home care.

Fig. 1

Relationship between mean Cognitive Performance Scale score and mean ADL Hierarchy scale score by country in the AdHOC □ and IBenC ◊ samples. BE = Belgium, FI=Finland, GE = Germany, IC=Iceland, IT = Italy, NL = the Netherlands. AdHOC = mean values in the AdHOC study and IBenC = mean values in the IBenC study. Mean score in AdHOC and IBenC is without Belgium. Chi-square test p < 0,05

Fig. 2

Hours of home care the last 7 days before evaluation. Difference between countries and studies are significant p < 0,05. * Total for Italy, Iceland, the Netherlands, Finland, and Germany. Belgium didn’t participate in AdHOC. Chi-square test p < 0,05

Fig. 3

Relationship between score on ADLH scale and the number of minutes of home care received for the countries together in the IBenC study, the last 7 days before evaluation. Chi-square test p < 0,05

Fig. 4

Relationship between score on ADLH scale and the number of minutes of home care received for each country in the IBenC study, the last 7 days before evaluation. *significant Chi-square test p < 0,05

Fig. 5

Relationship between score on CPS scale and the number of minutes of home care received for the countries together in the IBenC study, the last 7 days before evaluation. Chi-square test p < 0,05

Fig. 6

Relationship between score on CPS scale and the number of minutes of home care received for each country in the IBenC study. *significant Chi-square test p < 0,05