Costs and person-centred outcomes associated with clustered 'homelike' models of residential aged care: an Australian cross-sectional study

Research Objective:
Providing residential care for people living with dementia in nursing homes providing accommodation in smaller groups that aim to optimise the resident’s function and independence in a more home-like or normalised environment, such as the Green House model, is increasing in availability. However, there is little information available on the costs associated with running and establishing these types of homes. The objective of this study was 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 an Australian standard model of care.

Study Design:

A cross-sectional study with 12-month retrospective linked health service usage data. Main outcomes were quality of life, quality of care, hospitalisations and facility running costs. Capital establishment costs were obtained for 8 clustered facilities and 9 standard care facilities.

Population Studied:

Residents of 17 aged care facilities in 4 Australian states providing either ‘homelike’ cluster or standard models of residential aged 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. 901 residents were eligible and 541 consented (24% self-consent, 76% proxy). All residents in a clustered ‘homelike’ model of care had either a dementia diagnosis or a Psychogeriatric Assessment Scales - Cognitive Impairment Scale score of five or more indicative of cognitive impairment in comparison to 79% of those in Australian standard care facilities.

Principal Findings:

After adjustments for potential confounding factors of the residents and facilities, 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 in standard care. Unadjusted facility running costs were similar for the two models of care, but, after adjustments, it was estimated that overall there is a saving of $AU12, 962 (2016 values; 95% CI, $11,092 to $14,831) per person per year in residential care costs. The mean adjusted total annual cost for providing health and residential aged care in the clustered model was $AU14,270 lower than for the standard model (16% saving; P = 0.11). Build cost per metre2 is similar between models, but metre2/bed is 20% higher for clustered models (mean ± standard deviation 69.4±7.7 m2 clustered versus 57.7±3.2 m2 standard).

Conclusions:

Clustered domestic models of residential care are associated with better quality of life and fewer hospitalisations with no increment in whole of system costs.

Implications for Policy or Practice:

Provision of care in clustered domestic models may be a financially feasible approach with benefits to government and society and these models should be incentivised.