Costs of occupational therapy in residential homes and its impact on service use

Abstract

The Care Home Activity Project was a feasibility study examining the effect of occupational therapy on levels of depression and quality of life of residents in care homes. This paper describes the costs of the one year occupational therapy intervention, the use and cost of services received by the residents both before and after the intervention and compares these with the services received by a control group over the same period. Eight homes in northern England were included in the study with four homes receiving the services of a full-time occupational therapist, the remaining four acting as the control group. Services received by residents in both groups were recorded at the beginning and end of the one year study. The cost of the occupational therapy intervention was computed from published unit costs with adjustments for travel, equipment costs and methods of working. There was a significant increase in the likelihood of using social services in the intervention homes. This could be explained by previously unrecognised needs being revealed by the therapists. There may have been a reduction in health costs in the intervention group. At 2005 levels, the net cost of providing the occupational therapy service was pounds 16 (E 23) per resident per week. This study demonstrates that occupational therapy is feasible in residential homes at modest cost. It may uncover unmet needs for some services. Future studies should match groups for hospital use at baseline.

Advancing aged care: a systematic review of economic evaluations of workforce structures and care processes in a residential care setting

“…NoNHPT/OT delivered at a 1:50 ratio was more effective at promoting, maintaining, or limiting decline in functional status. The resulting reduction in required care delivery resources was estimated to provide an annual cost saving of $283 per bed (a 1% cost reduction) Schneider et al [35], GBR1.0 FTE occupational therapistUsual care8190Non-randomised experimental trialCost analysis; health and social services1 year2002–2003;Published unit costs, inflated to 2005; GBP NoCHIntervention group showed a significant increase in the likelihood of using social services. At 2005 levels, net cost of providing occupational therapy was £16 per resident per week Sharkey et al [37], USAGreen House modelUsual care27240Cross-sectionalCost analysis; institutionalN/A2008–2009;Observational, interview, and survey methods at participating facilities; N/A NoSNFTotal staffing time (excluding administration) in Green House facilities was 18 min less per resident per day that traditional facilities.…”

“…Four studies evaluated the costs and effects of enhanced staffing levels, including increasing the amount of direct nursing care time for each resident [20], employing a full-time occupational therapist [35], increasing the staffing level of both physical and occupational therapists [28], and implementing off-hours physician coverage via telemedicine [34]. Results suggest that enhanced staffing levels, whilst being associated with increases in staffing costs provide the potential for cost savings in other areas.…”

“…The resulting reduction in required care delivery resources was estimated to provide an annual cost saving to the institution of $283 per resident [28]. A third study which evaluated the benefit of a full-time occupational therapist reported a significant reduction in secondary health care costs (including hospital admissions) and an increase in the use of social services, though the cost of providing occupational therapy was not offset by the savings in health care [35]. Finally, a fourth study found that increasing the availability of physician care during the off-hours via a dedicated telemedicine service decreased annual hospitalisations by 11.3% annually [34].…”

“…Results from three studies suggest a potential for cost savings to the health care sector by increasing the amount of direct care time provided to each resident [20, 28, 35]. Benefits reported were wide ranging from reductions in the frequency of hospitalisations to improved functional status for the residents.…”

Why Is It So Difficult to Evaluate Nursing Interventions in Dementia

“…Following the assessment of the abstracts by two independent reviewers, 287 clinical and 213 health economic publications were included for a closer examination of their relevance for the subject. Finally, 20 clinical [10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29] and 6 health economic [30, 31, 32, 33, 34, 35] publications met the inclusion criteria (details for the clinical part can be seen in table 2). …”