Clustered 'Homelike' Models of Residential Aged Care Are Associated with Fewer Hospitalisations, Better Quality of Life and Similar Costs: An Australian Cross-Sectional Study

Objective: To examine the consequences in terms of resident centred outcomes and costs of living in a ‘homelike’ clustered model of residential aged care in comparison to a standard Australian model.

Method: A cross-sectional study with 12-month retrospective linked health service usage data. 17 residential care facilities in 4 Australian states providing either ‘homelike’ cluster or standard model of care. Inclusion criteria were those residing in care for 12 months or longer, not in immediate palliative care, including those with cognitive impairment, having a family member willing to participate on their behalf if necessary. 901 residents were eligible and 541 consented (24% self-consent, 76% proxy). Main outcomes were quality of life, quality of care and hospitalisations.

Result: All residents in a clustered ‘homelike’ model of care had either a dementia diagnosis or a PAS-Cog of five or more indicative of cognitive impairment in comparison to 79% of those in standard care facilities. After adjustments, individuals residing in clustered ‘homelike’ models of care had better quality of life (EQ5D5L difference 0.107, 95%CI 0.028 - 0.186), better consumer-rated quality of care (Consumer Choice Index - 6 Dimension (CCI-6D) difference 0.138, 95%CI 0.073 - 0.203), lower hospitalisation rates (rate ratio [RaR] difference = 0.318, 95% CI 0.128 - 0.786) and lower ED presentation rates (RaR difference = 0.273, 95%CI 0.142 - 0.526), in comparison to those residing in a standard care facility. The rate of general practitioner consultations did not differ (RaR difference = 1.31, 95%CI 0.752- 2.28). There was a predicted total (health and residential care) annual cost saving of approximately AU$14,000 (2016, 16% of total) per person associated with the clustered model of care, after adjustments, which was statistically significant considering costs to government.

Conclusion: Clustered domestic models of residential care are associated with better quality of life and fewer hospitalisations with no increment in whole of system costs. Provision of care in clustered domestic models may be a financially beneficial approach for government and society and these models should be further explored. More information is needed on financial, attitudinal and regulatory barriers to expansion of clustered housing approaches in residential aged care.