A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults

Abstract

A randomised controlled trial was conducted to test the effectiveness of the Home Independence Program (HIP), a restorative home‐care programme for older adults, in reducing the need for ongoing services. Between June 2005 and August 2007, 750 older adults referred to a home‐care service for assistance with their personal care participated in the study and received HIP or ‘usual’ home‐care services. Service outcomes were compared at 3 and 12 months. Subgroups of 150 from each group were also compared on functional and quality of life measures. Data were analysed by ‘intention‐to‐treat’ and ‘as‐treated’. The intention‐to‐treat analysis showed at 3 and 12 months that the HIP group was significantly less likely to need ongoing personal care [Odds ratio (OR) = 0.18, 95% CI = 0.13–0.26, P < 0.001; OR = 0.22, 95% CI = 0.15–0.32, P < 0.001]. Both subgroups showed improvements on the individual outcome measures over time with the only significant differences being found at 12 months for Instrumental Activities of Daily Living (IADL) in the as‐treated analysis. Contamination of the control group by an increased emphasis on independence across the home‐care agency involved, together with other methodological problems encountered, is thought to account for the few differences between groups in individual outcomes. Despite no difference between the groups over time in their overall ADL scores, a significantly smaller proportion of the HIP group required assistance with bathing/showering, the most common reason for referral, at 3 and 12 months. The results support earlier findings that participating in a short‐term restorative programme appears to reduce the need for ongoing home care. The implementation of such programmes more broadly throughout Australia could substantially offset the projected increase in demand for home care associated with the five‐fold projected increase in numbers of the oldest old expected over the next 40 years.

Evidence for the long term cost effectiveness of home care reablement programs

“…Our results are consistent with previous studies that have used comparison groups with greater baseline demographic similarity and shown the effectiveness of reablement services across diverse target groups 10,20. This suggests that it is unlikely that we have incorrectly attributed the beneficial effect to the service rather than differences between individuals.…”

“…In the US and New Zealand these types of services are labeled restorative home care/support services 7–9. In Australia both terms are used 2,10. Whatever the label and differences between countries in how these services have developed and are implemented by individual service providers, all have similar objectives and need to be considered when assessing the current evidence base regarding their effectiveness.…”

“…This has included an operational trial, a small nonrandomized controlled trial, and a large randomized controlled trial 10,14,22. All three studies showed that individuals who received the reablement service, the Home Independence Program (HIP), used significantly fewer home care services than individuals who received conventional home care.…”

Outcomes of reablement and their measurement: Findings from an evaluation of English reablement services

“…However the previous study did not find a difference in social care–related quality of life between the cohorts at 12 months follow‐up, nor were changes in scores between baseline and 12‐month follow‐up statistically significant. Two other studies (Lewin, De San Miguel, et al, ; Tuntland, Aaslund, Espehaug, Forland, & Kjeken, ) – both randomised controlled trials comparing reablement with usual care – used alternative measures of quality of life: the COOP/Wonka and the Assessment of Quality of Life Scale (AQoL). Neither report reablement significantly affecting health‐related quality of life at follow‐up time points compared to usual care.…”

“…The absence of a comparator group means we cannot attribute these improvements to reablement and they may, instead or in part, be due to non‐specific recovery processes observed after, for example, a fracture has healed (Tuntland et al, ). However, a study which did use a comparator groups found differences between groups in (practitioner‐reported) abilities to carry out extended activities of daily living (favouring the reablement group) were not observed until some months after discharge (Lewin, De San Miguel, et al, ).…”