Dataset Information

Direct health and residential care costs of people living with dementia in Australian residential aged care.

ABSTRACT: This analysis estimates the whole-of-system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.Data were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals.The average annual whole-of-system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out-of-hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia.This study provides the first estimate of the whole-of-system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom-up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top-down, population costing approaches are taken.

SUBMITTER: Gnanamanickam ES

PROVIDER: S-EPMC6032872 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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Direct health and residential care costs of people living with dementia in Australian residential aged care.

Gnanamanickam Emmanuel S ES Dyer Suzanne M SM Milte Rachel R Harrison Stephanie L SL Liu Enwu E Easton Tiffany T Bradley Clare C Bilton Rebecca R Shulver Wendy W Ratcliffe Julie J Whitehead Craig C Crotty Maria M

International journal of geriatric psychiatry 20180102 7

<h4>Objectives</h4>This analysis estimates the whole-of-system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.<h4>Methods</h4>Data were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the deme ...[more]

PMID: 29292541

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Project description:IntroductionPeople living with dementia in care homes can benefit from palliative approaches to care; however, not all will require specialist palliative care. The generalist aged care workforce is well placed to provide most of this care with adequate training and support systems in place, but little is known about their experiences.ObjectiveTo describe staff perspectives on providing quality end-of-life care for people living with dementia in residential care and their families.MethodsFocus groups and semi-structured interviews were conducted with residential aged care managerial and frontline staff in Australia who were caring for residents living with dementia and end-of life needs. A comprehensive, then snowballing sampling strategy was used in participating care homes. Transcripts were analyzed using reflexive thematic analysis.ResultsFifteen semi-structured interviews and six focus groups were undertaken with 56 participants across 14 sites across two Australian states. Five themes were identified: putting the resident at the center (creating homes not hospitals, knowing the individual, a case management approach); articulating goals to grant wishes (initiating the conversation, broadening death literacy, avoiding hospitalization); a collective call to action (staffing the home, recognizing deterioration and escalating issues, communication channels and engaging GPs, managing medications, psychosocial supports); educating to empower staff (governance and guidance, mentoring juniors, self-care); and facilitating family acceptance (setting expectations, partnering in care, access at all hours).DiscussionAged care staff are committed to providing person-centered palliative and end-of-life care for people living with dementia, recognizing the intrinsic value of each resident, regardless of their declining state. Frontline and managerial staff consider advance care planning, collectively working as part of a multidisciplinary team, access to targeted palliative and end-of-life education and training, and engaging families as key priorities to providing high quality care in care homes.

Project description:BackgroundSelf-efficacy is developed through a person's interaction with his/her physical and social environment. Self-efficacy in caring is an essential attribute of care workers to develop a positive attitude towards their clients, improve work performance, and enhance job satisfaction. Care workers' self-efficacy may vary according to the context in which the care is being provided. Aged care is a multidimensional and challenging setting, and characteristics of aged care services are different from those of acute care services. The objective of this review is to give an overview of the self-efficacy of residential aged care workers in caring for older people and factors influencing their self-efficacy.MethodsThe protocol for this review is based on the Joanna Briggs Institute Reviewer's Manual for Scoping Review. A systematic search of the literature on electronic databases MEDLINE, PsycINFO, CINAHL, AgeLine, SCOPUS, and ProQuest Dissertations and Theses Global will be carried out using predefined search terms to identify relevant studies. This review will include studies that examined the self-efficacy of direct care workers in caring for older people living in residential aged care facilities. All primary studies irrespective of the study design will be included. Studies conducted to develop measures or studies with informal care workers or students as study participants will not be considered. Two reviewers will independently conduct title and abstract screening, full-text screening, and data charting. A third reviewer will resolve discrepancies, while the final decision for conflicting studies will be made by consensus within the review team. Descriptive statistics will be utilized to analyze the quantitative findings, and the result will be presented in narrative form accompanied by tables and charts. Content analysis will be carried to analyze the qualitative findings and will be presented in narrative form supported by illustrative quotations.DiscussionThis study will be an important source of knowledge to policymakers and aged care providers to understand the self-efficacy of aged care workers to support and enhance their self-efficacy and thereby improve their caring behaviors towards their clients.Scoping review registrationJoanna Briggs Institute Systematic Review Register with the title "A scoping review of factors influencing caring efficacy of direct care workers providing care to older people".

Project description:BackgroundThe aged care system in Australia is under pressure. Residential aged care facilities (RACFs) and general practitioners (GPs) have difficulty providing the care needed by their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs.MethodsUsing the NASSS framework, we synthesised descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and a thematic analysis of interview data collected from GPs, RACF and MED service staff, and family members of residents.ResultsMost calls to MED (179/209) were resolved with in-house treatment thereby reducing ambulance usage and hospital admissions. Interviews further revealed that MED enabled timely care for residents who were unwell but did not need hospital transfer. Technology, training, and rapid access to MED assisted RACF staff and complemented usual GP care. MED potentially reduced GP burnout. Refresher training was considered important especially in RACFs with high staff turnover, as was greater afterhours access to medications.ConclusionsThe afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses.

Dataset Information

Direct health and residential care costs of people living with dementia in Australian residential aged care.

Publications

Direct health and residential care costs of people living with dementia in Australian residential aged care.

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