Search results for ‘Subject term:"home care"’ Sort:
Results 1 - 3 of 3
Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status? A Canadian experience
- Authors:
- LAPORTE Audrey, CROXFORD Ruth, COYTE Peter C.
- Journal article citation:
- Health and Social Care in the Community, 15(2), March 2007, pp.108-119.
- Publisher:
- Wiley
The present quantitative study evaluates the degree to which socioeconomic status (SES), as opposed to perceived need, determines utilisation of publicly funded home care in Ontario, Canada. The Registered Persons Data Base of the Ontario Health Insurance Plan was used to identify the age, sex and place of residence for all Ontarians who had coverage for the complete calendar year 1998. Utilisation was characterised in two dimensions: (1) propensity − the probability that an individual received service, which was estimated using a multinomial logit equation; and (2) intensity − the amount of service received, conditional on receipt. Short- and long-term service intensity were modelled separately using ordinary least squares regression. Age, sex and co-morbidity were the best predictors of whether or not an individual received publicly funded home care as well as how much care was received, with sicker individuals having increased utilisation. The propensity and intensity of service receipt increased with lower SES, and decreased with the proportion of recent immigrants in the region, after controlling for age, sex and co-morbidity. Although the allocation of publicly funded home care service was primarily based on perceived need rather than ability to pay, barriers to utilisation for those from areas with a high proportion of recent immigrants were identified. Future research is needed to assess whether the current mix and level of publicly funded resources are indeed sufficient to offset the added costs associated with the provision of high-quality home care.
Recruitment issues in healthcare research: the situation in home care
- Authors:
- MILLER Karen-Lee, McKEEVER Patricia, COYTE Peter C.
- Journal article citation:
- Health and Social Care in the Community, 11(2), March 2003, pp.111-123.
- Publisher:
- Wiley
A global shift in the setting of healthcare from hospitals and long-term care institutions to homes and communities has been accompanied by the growth of interest in the home as a site of healthcare research. Home care researchers have identified the recruitment of research subjects as a significant concern. This descriptive, exploratory study used qualitative, semi-structured interviews with 9 home care researchers to illuminate the challenges related to recruitment. Results suggest that while home care research shares recruitment issues common to other forms of health research, it has unique concerns. Factors include non-dedicated recruiters, the current context of healthcare restructuring, and gatekeeper and participant feelings about the home as a setting for care and research. Reasons for refusal to participate may be more complex in home care research given the meanings care recipients attribute to their 'homes'. Home care researchers may also face unique ethical and/or moral dilemmas. Recommends routine reporting of recruitment problems, increased inclusion of minority subjects to ensure sample representativeness and further studies of the subjective meanings of 'home' as associated with healthcare treatment.
Societal costs of home and hospital end-of-life care for palliative care patients in Ontario, Canada
- Authors:
- YU Mo, GUERRIERE Denise N., COYTE Peter C.
- Journal article citation:
- Health and Social Care in the Community, 23(6), 2015, pp.605-618.
- Publisher:
- Wiley
In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00CDN = $1.00USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of costs borne by different stakeholders. (Publisher abstract)