Worldwide increases in the numbers of older people alongside an accompanying international policy incentive to support ageing-in-place have focussed the importance of home-care services as an alternative to institutionalisation. Despite this, funding models that facilitate a responsive, flexible approach are lacking. Casemix provides one solution, but the transition from the well-established hospital system to community has been problematic. This research seeks to develop a Casemix funding solution for home-care services through meaningful client profile groups and supporting pathways. Unique assessments from 3,135 older people were collected from two health board regions in 2012. Of these, 1,009 arose from older people with non-complex needs using the interRAI-Contact Assessment (CA) and 2,126 from the interRAI-Home-Care (HC) from older people with complex needs. Home-care service hours were collected for 3 months following each assessment and the mean weekly hours were calculated. Data were analysed using a decision tree analysis, whereby mean hours of weekly home-care was the dependent variable with responses from the assessment tools, the independent variables. A total of three main groups were developed from the interRAI-CA, each one further classified into “stable” or “flexible.” The classification explained 16% of formal home-care service hour variability. Analysis of the interRAI-HC generated 33 clusters, organised through eight disability “sub” groups and five “lead” groups. The groupings explained 24% of formal home-care services hour variance. Adopting a Casemix system within home-care services can facilitate a more appropriate response to the changing needs of older people.

REFERENCES

Aspinal, F., Glasby, J., Rostgaard, T., Tuntland, H., & Westendorp, R. G. (2016). New horizons: Reablement – Supporting older people towards independence. Age and Ageing, 45, 574–578.
10.1093/ageing/afw094
Web of Science® Google Scholar
Björkgren, M., Fries, B., & Shugarman, L. (2000). A RUG-III case-mix system for home-care. Canadian Journal on Aging/La Revue Canadienne du Vieillissement, 19, 106–125.
10.1017/S0714980800013921
Web of Science® Google Scholar
Calver, J., Holman, C., & Lewin, G. (2004). A preliminary casemix classification system for Home and Community Care Clients in Western Australia. Australian Health Review, 27, 13.
10.1071/AH042720027
PubMed Google Scholar
Cameron, J. (1985). Case-mix and resource use in long-term care. Medical Care, 23, 296–309.
10.1097/00005650-198504000-00002
CAS PubMed Web of Science® Google Scholar
Carpenter, I., Gambassi, G., Topinkova, E., Schroll, M., Finne-Soveri, H., Henrard, J., … Ljunggren, G. (2004). Community care in Europe. The aged in home-care project (AdHOC). Aging Clinical and Experimental Research, 16, 259–269.
10.1007/BF03324550
PubMed Web of Science® Google Scholar
Eagar, K., & Hindle, D. (1994). Short introduction to Casemix. Wollongong, Australia: Dept of Human Services and Health, University of Wollongong.
Google Scholar
Fetter, R., Shin, Y., Freeman, J., Averill, R., & Thompson, J. (1980). Case mix definition by diagnosis-related groups. Medical Care, 18, i-53.
Google Scholar
Fries, B. E., & Cooney, L. M. (1985). Resource utilization groups: A patient classification system for long-term care. Medical Care, 23, 110–122.
10.1097/00005650-198502000-00002
CAS PubMed Web of Science® Google Scholar
Fries, B., Schneider, D., Foley, W., Gavazzi, M., Burke, R., & Cornelius, E. (1994). Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III). Medical Care, 32, 668–685.
10.1097/00005650-199407000-00002
CAS PubMed Web of Science® Google Scholar
Glendinning, C., & Newbronner, E. (2008). The effectiveness of home-care reablement – Developing the evidence base knowledge base. Journal of Integrated Care, 16, 32–39.
10.1108/14769018200800031
Google Scholar
Goldberg, H., Delargy, D., Schmitz, R., & Moore, T. (1999). Case-mix adjustment for national home health prospective payment system: Second Interim Report. Cambridge, MA: Abt Associates.
Google Scholar
Heppenstall, S. (2015). Funding community care for older adults: Testing the applicability of the interRAI casemix in three New Zealand District Health Boards. Dunedin: Masters of Health Science, University of Otago.
Google Scholar
Hirdes, J., Curtin-Telegdi, N., Poss, J., Gray, L., Berg, K., Stolee, P., … Declercq, A. (2010). interRAI Contact Assessment (CA) form and User's manual: A screening level assessment for emergency department and intake from community/hospital. Version, 9, 2.
Google Scholar
InterRAI New Zealand. (2016). Which interRAI assessment to use and when to use it Information for assessors. HEALTH, M. O. (ed.). Wellington: TASS.
Google Scholar
Kent, J., Payne, C., Stewart, M., & Unell, J. (2005). Evaluation of the home-care reablement pilot project. In: COMMUNITY, C. F. G. C. A. & CARE STUDIES (eds.). Leicester: De Montfort University.
Google Scholar
King, A., Parsons, M., & Robinson, E. (2012). A restorative home-care intervention in New Zealand: Perceptions of paid caregivers. Health & Social Care in the Community, 20, 70–79.
10.1111/j.1365-2524.2011.01020.x
PubMed Web of Science® Google Scholar
King, A., Parsons, M., Robinson, E., & Jörgensen, D. (2012). Assessing the impact of a restorative home-care service in New Zealand: A cluster randomised controlled trial. Health & Social Care in the Community, 20, 365–374.
10.1111/j.1365-2524.2011.01039.x
PubMed Web of Science® Google Scholar
Legg, L., Gladman, J., Drummond, A., & Davidson, A. D. (2015). A systematic review of the evidence on home-care reablement services. Clin Rehabil, 30, 741–749.
10.1177/0269215515603220
PubMed Web of Science® Google Scholar
Lewin, G. F., Alfonso, H. S., & Alan, J. J. (2013). Evidence for the long term cost effectiveness of home-care reablement programs. Clinical Interventions in Aging, 8, 1273–1281.
10.2147/CIA.S49164
PubMed Google Scholar
Lewin, G., Concanen, K., & Youens, D. (2016). The Home Independence Program with non-health professionals as care managers: An evaluation. Clinical Interventions in Aging, 11, 807–817.
10.2147/CIA.S106180
PubMed Web of Science® Google Scholar
Lewin, G., & Vandermeulen, S. (2010). A non-randomised controlled trial of the Home Independence Program (HIP): An Australian restorative programme for older home-care clients. Health and Social Care in the Community, 18, 91–99.
10.1111/j.1365-2524.2009.00878.x
CAS PubMed Web of Science® Google Scholar
Morris, J., Fries, B., Steel, K., Ikegami, N., Bernabei, R., Carpenter, I., … Topinková, E. (1997). Comprehensive clinical assessment in community setting: Applicability of the MDS-HC. Journal of the American Geriatrics Society, 45, 1017–1024.
10.1111/j.1532-5415.1997.tb02975.x
CAS PubMed Web of Science® Google Scholar
Newbronner, L., Baxter, M., & Chamberlain, R. (2007). Research into the longer-term effects of reablement services. In: UNIT, S. P. R. (ed.). York: University of York.
Google Scholar
Parsons, J., & Parsons, M. (2012). The effect of a designated tool on person-centred goal identification and service planning among older people receiving homecare in New Zealand. Health & Social Care in the Community, 20, 653–662.
10.1111/j.1365-2524.2012.01081.x
PubMed Web of Science® Google Scholar
Parsons, M., Senior, H., Kerse, N., Chen, M.-H., Jacobs, S., & Anderson, C. (2017). Randomised trial of restorative home-care for frail older people in New Zealand. Nursing Older People, 29, 27–33.
10.7748/nop.2017.e897
PubMed Google Scholar
Parsons, M., Senior, H., Kerse, N., Chen, M. H., Jacobs, S., Vander Hoorn, S., … Anderson, C. (2012). Assessment of Services Promoting Independence and Recovery in Elders (ASPIRE). Age and Ageing, 41, 722–728.
10.1093/ageing/afs113
PubMed Web of Science® Google Scholar
Parsons, J., Sheridan, N., Rouse, P., Robinson, E., & Connolly, M. (2013). A randomized controlled trial to determine the effect of a model of restorative home-care on physical function and social support among older people. Archives of Physical Medicine and Rehabilitation, 94, 1015–1022.
10.1016/j.apmr.2013.02.003
PubMed Web of Science® Google Scholar
Phillips, C., Dyer, J., Janousek, V., Halperin, L., & Hawes, C. (2008). Providing appropriate services to individuals in the community: A preliminary case-mix model for allocating personal care services. Journal of Health & Human Services Administration, 30, 24.
Google Scholar
Poss, J., Hirdes, J., Fries, B., McKillop, I., & Chase, M. (2008). Validation of Resource Utilization Groups Version III for Home-care (RUG-III/HC). Evidence from a Canadian Home-care Jurisdiction. Medical Care, 46, 8.
10.1097/MLR.0b013e31815c3b6c
Web of Science® Google Scholar
Resnick, B., Boltz, M., Galik, E., & Pretzer-Aboff, I. (2012). Restorative care nursing for older adults: A guide for all care settings. New York: Springer Publishing Company.
Google Scholar
Resnick, B., Galik, E., & Boltz, M. (2013). Function Focused Care approaches: Literature review of progress and future possibilities. J Am Med Dir Assoc, 14, 313–318.
10.1016/j.jamda.2012.10.019
PubMed Web of Science® Google Scholar
Sajtos, L., Rouse, P., Harrison, J., & Parsons, M. (2014). Case-mix system as a boundary object: The case of home-care services. Australasian Marketing Journal (AMJ), 22, 189–196.
10.1016/j.ausmj.2014.08.003
Google Scholar
Sokal, R. R. (1974). Classification: Purposes, principles, progress, prospects. Science, 185, 1115–1123.
10.1126/science.185.4157.1115
CAS PubMed Web of Science® Google Scholar
Sox, H. (1988). Medical decision making. Philadelphia, PA: ACP Press.
Google Scholar
Tessier, A., Beaulieu, M. D., McGinn, C. A., & Latulippe, R. (2016). Effectiveness of reablement: A systematic review. Healthc Policy, 11, 49–59.
PubMed Google Scholar
Weinstein, M., & Fineberg, H. (1980). Clinical decision analysis. Philadelphia, PA: WB Saunders.
Google Scholar
Werry, J. (1988). Diagnostic classification for the clinician. In E. Schopler, & G. B. Mesibov (Eds.), Diagnosis and assessment in autism (pp. 49–58). New York, NY: Plenum Press.
10.1007/978-1-4899-0792-9_4
Google Scholar

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