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The magnitude, share and determinants of unpaid care costs for home-based palliative care service provision in Toronto, Canada
- Authors:
- CHAI Huamin, et al
- Journal article citation:
- Health and Social Care in the Community, 22(1), 2014, pp.30-39.
- Publisher:
- Wiley
Little is known about the economic outcomes associated with home-based unpaid care-giving at the end of life. This Canadian study examines the magnitude and share of unpaid care costs (ie by family caregivers) in total healthcare costs for home-based palliative care patients, from a societal perspective and also considers the sociodemographic and clinical factors that account for variations in this share. One hundred and sixty-nine caregivers of patients with a malignant neoplasm were interviewed from time of referral to a home-based palliative care programme provided by palliative care services in Toronto, Canada, until death. Information regarding palliative care resource utilisation and costs, time devoted to caregiving and sociodemographic and clinical characteristics was collected between July 2005 and September 2007. Over the last 12 months of life, the average monthly cost was $14 924 (2011 CDN$) per patient. Unpaid care-giving costs were the largest component – $11 334, accounting for 77% of total palliative care expenses, followed by public costs ($3211; 21%) and out-of-pocket expenditures ($379; 2%). In all cost categories, monthly costs increased exponentially with proximity to death. The share of unpaid care costs of total costs was driven by patients' and caregivers' sociodemographic characteristics. Results suggest that overwhelming the proportion of palliative care costs is unpaid care-giving. This share of costs requires urgent attention to identify interventions aimed at alleviating the heavy financial burden and to ultimately ensure the viability of home-based palliative care in future. (Edited publisher abstract)
Social care costs for community-dwelling older people living with frailty
- Authors:
- NIKOLOVA Silviya, et al
- Journal article citation:
- Health and Social Care in the Community, 30(3), 2022, pp.e804-e811.
- Publisher:
- Wiley
International evidence indicates that older people with frailty are more likely to access social care services, compared to nonfrail older people. There is, however, no robust evidence on costs of social care provided for community-dwelling older people living with frailty in their own homes. The main objective of this study was to examine the relationship between community-dwelling older people living with frailty, defined using the cumulative deficit model, and annual formal social care costs for the 2012–2018 period. A secondary objective was to estimate formal social care spending for every 1% reduction in the number of older people who develop frailty over 1 year. Secondary analysis of prospective cohort data from two large nationally representative community-based cohort studies in England was performed. Respondents aged ≥75 were used in the main analysis and respondents aged 65–74 in sensitivity testing. We used regression tree modelling for formal social care cost analysis including frailty, age, gender, age at completing education and living with partner as key covariates. We employed a minimum node size stopping criteria to limit tree complexity and overfitting and applied 'bootstrap aggregating' to improve robustness. We assessed the impact of an intervention for every 1% decrease in the number of individuals who become frail over 1 year in England. Results show that frailty is the strongest predictor of formal social care costs. Mean social care costs for people who are not frail are £321, compared with £2,895 for individuals with frailty. For every 1% of nonfrail people not transitioning to frailty savings of £4.4 million in annual expenditures on formal social care in England are expected, not including expenditure on care homes. Given considerably higher costs for individuals classed as frail compared to nonfrail, a successful intervention avoiding or postponing the onset of frailty has the potential to considerably reduce social care costs. (Edited publisher abstract)
Cost‐minimisation analysis of home care reablement for older people in England: a modelling study
- Authors:
- BAUER Annette, et al
- Journal article citation:
- Health and Social Care in the Community, 27(5), 2019, pp.1241-1250.
- Publisher:
- Wiley
Many governments have introduced or encouraged home‐care reablement schemes for older people at home with the aim of improving outcomes and reducing costs. The authors examined if such schemes have the potential to reduce costs from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England. The study was carried out to inform recommendations of a national guideline. Cost‐minimisation analysis was carried out using decision‐analytic Markov modelling. Home‐care reablement was compared with standard home care. Costs included those of the intervention, home care and hospital admission. Uncertainty was explored using univariate and probabilistic sensitivity analysis. Mean costs per person were £56,499 (95% confidence interval 55,690 to 57,307) in the reablement group, and £58,560 (95% confidence interval 57,800 to 59,319) in the standard care group. The mean difference was ‐£2,061 (95% confidence interval 1,933 to 2,129). The probability that home‐care reablement costs less than standard home care was 94.5% (95% confidence interval 93.1 to 95.9). In sensitivity analyses, this probability remained above 85% in all scenarios. Home‐care reablement can be a successful cost‐minimisation strategy for supporting some older people. More research is needed about the impact of home‐care reablement on health outcomes for different groups of older people; and the effects of different durations of reablement on outcomes and costs for different subpopulations. (Edited publisher abstract)
An overview of the UK domiciliary care sector: UKHCA summary paper
- Authors:
- O'BRIEN Donna, FRANCIS Joyce
- Publisher:
- United Kingdom Homecare Association
- Publication year:
- 2010
- Pagination:
- 29p.
- Place of publication:
- Sutton
The United Kingdom Homecare Association is the professional association of homecare providers from the independent, voluntary, not-for-profit and statutory sectors providing domiciliary care, home nursing and allied services. These summary figures are aimed at researchers, management consultants and organisations considering entry into the homecare sector. The paper provides data covering homecare services in England, Wales, Scotland, and Northern Ireland, including number of service users, intensity of care, public expenditure, supply of homecare, provider numbers, standards and workforce.
Moving toward Medicare home health coverage for people with Alzheimer’s disease
- Author:
- CABIN William D.
- Journal article citation:
- Journal of Gerontological Social Work, 51(1/2), 2008, pp.77-86.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Over 75% of care for people in the USA with Alzheimer’s disease or other dementias is provided by family members, imposing a significant personal burden in terms of stress, depression, social isolation and other problems. Despite the existence of reputable evidence in favour of the benefits of home- and community-based palliative care provision, this is not incorporated within Medicare which is dominated by the curative, drug-focused medical model. As a result, there are significant unmet client and carer needs, and high costs to all parties including Medicare when, for example, premature admission to institutional care follows the failure to provide any support for carers. There is a strong case for the federal government to fund a demonstration project to test the efficacy of palliative home care for improving quality of life and reducing costs for Medicare clients with Alzheimer’s disease, and for their carers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
The report of the Older People's Inquiry into 'that bit of help'
- Editors:
- RAYNES Norma, CLARK Heather, BEECHAM Jennifer, (eds.)
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2006
- Pagination:
- 125p.
- Place of publication:
- York
This report of the Older People’s Inquiry into ‘That Bit of Help’ documents the experiences of older people and professionals working together to identify gaps in service provision for older people living in their own homes. The report focuses on how to involve older people alongside the professionals, as equals, in identifying what services they want and value. It notes that older people are able to take account of costs of service provision in an environment where resources are limited, and with this information they are able to prioritise the service provision which they require. A sound model is provided to ensure the central involvement of older people in prioritising valued services; the methods used would be easily transferred to local level. The chosen ‘baker’s dozen’ of small ways in which life can be made better for older people gives ideas of what services might be developed. This report includes an overview of the Inquiry’s findings, the methodology used to select examples of good practice, and the methodology used for costing the examples chosen by Inquiry members, along with their unit costs.
Cheaper for whom: costs experienced by formal caregivers in adult family living programs
- Authors:
- DOSMAN Donna, KEATING Norah
- Journal article citation:
- Journal of Aging and Social Policy, 17(2), 2005, pp.67-83.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
A current emphasis in Canadian public policy is on community care for frail seniors. Such care is viewed as attractive in part because public costs are lower than for traditional nursing home care. Adult Family Living (AFL) is seen as an exemplar of this community focus. Data from a multi-model evaluation of residential continuing care in western Canada are used to show that while AFL programs have lower public costs than nursing homes, AFL caregivers incur high levels of economic and non-economic costs. We address the question of the sustainability of this approach to community-based residential care in light of the apparent transfer of public costs to AFL caregivers.
Homecare cost of care toolkit
- Author:
- LOCAL GOVERNMENT ASSOCIATION
- Publisher:
- Local Government Association
- Publication year:
- 2022
- Place of publication:
- London
- Edition:
- 4th ed.
This Excel-based toolkit will help councils and partners obtain a shared understanding of the costs of providing home care. The toolkit is open access and so can be freely used by all councils and providers. The intended purpose of the toolkit is to support improvements in the level and quality of information about the costs of delivering home-based care and support. Part A of the toolkit, the Standard (Cost+) Worksheet, utilises a traditional unit costing approach and will help users understand the individual operating costs and variances that make up the cost of homecare, whilst adding additional flexibility and costs that may not usually be considered. The toolkit includes, as far as practical, all expected cost lines that homecare providers incur in delivering services. While additional cost lines may exist within individual homecare providers, feedback from extensive engagement with stakeholders, including care providers, has arrived at those that are included in the toolkit. This part of the toolkit also includes additional blank lines to allow the user to add cost lines that are not already included but should be factored into any cost of care exercise. Part B of the toolkit, the Sensitivity Analysis Worksheet, can be used to generate 'what if' scenarios to see, at-a-glance, the impact of changing costs, volumes and price points on the profitability of the provider / branch / market as a whole. Part C, the Data Output Worksheet, will automatically be populated with key information from Part A and can be amended and copied and pasted elsewhere to allow for further analysis. (Edited publisher abstract)
Catastrophic costs of care at home for self-funders
- Authors:
- BEEDELL Phoebe, et al
- Publishers:
- Wellcome Trust, University of Lincoln, University of Brighton, University of Birmingham
- Publication year:
- 2021
- Pagination:
- 9
This briefing draws on research findings from the project Ethical Issues in Self-funded Social Care: Co-producing knowledge with older people. This participatory research project explored how older people experience the process of finding and paying for personal care from their own resources in three local authority areas in England. By engaging closely with the lived experiences of older people who pay for their own domiciliary and live-in care, this research briefing highlights their financial concerns and their position within the care market, and reveals the excessive financial burden that older people may have to bear when they are paying for care in their own homes. Older people who pay for care in their own home are almost invisible in policy and practice. Little is known about the ways in which older self-funders navigate the care market and negotiate buying care in a complex and fragmented care system. The research found that many older people pay thousands, sometimes hundreds of thousands of pounds in total, for care provided in their own homes. Many of those whose care needs were not eligible for state-funded support were struggling to pay for the care they needed: the costs for care at home can be catastrophic in terms of the burden they place on self-funders; not all self-funders are well-off; some older people struggle to afford the care they need; the amount people pay for care is likely to rise as care costs increase and/or the need for care increases as their health and abilities decline; many older people did not fully appreciate the implications that running out of money would have for their care; some people have to make decisions about care based on pragmatic calculations about how long they, or their relative, will live. (Edited publisher abstract)
A minimum price for homecare (April 2021 to March 2022)
- Author:
- ANGEL Colin
- Publisher:
- United Kingdom Homecare Association
- Publication year:
- 2021
- Pagination:
- 16
- Place of publication:
- Wallington
- Edition:
- Version 8.0
Using a costing model developed by the UKHCA, this report estimates the minimum price for homecare services purchased by councils and the NHS at the prevailing National Minimum Wage (including the National Living Wage), the Scottish Living Wage, the UK Living Wage and London Living Wage. The minimum price model covers the minimum legally compliant pay rate for careworkers (excluding any enhancements for unsocial hours working), their travel time, mileage and wage-related on-costs. The rate also includes the minimum contribution towards the costs of running a care business which complies with quality requirements at a financially sustainable level. These new rates exclude the additional costs of personal protective equipment (PPE) which is specifically required during the coronavirus pandemic. It provides four hourly rates for contact time, effective from April 2021. A minimum rate of £21.43 per hour to comply with a combination of the prevailing rates of the National Minimum Wage (NMW) and the National Living Wage (NLW); a minimum rate of £22.73 per hour to meet the voluntary UK Living Wage (outside London); a rate of £22.73 per hour to meet the Scottish Living Wage; and a minimum rate of £25.70 per hour for the (voluntary) London Living Wage. (Edited publisher abstract)