Patterns of home and community care use among older participants in the Australian Longitudinal Study of Women’s Health

Abstract

The aims of this study were to investigate patterns of home and community care (HACC) use and to identify factors influencing first HACC use among older Australian women. Our analysis included 11,133 participants from the Australian Longitudinal Study of Women's Health (1921-1926 birth cohort) linked with HACC use and mortality data from 2001 to 2011. Patterns of HACC use were analysed using a k-median cluster approach. A multivariable competing risk analysis was used to estimate the risk of first HACC use. Approximately 54% of clients used a minimum volume and number of HACC services; 25% belonged to three complex care use clusters (referring to higher volume and number of services), while the remainder were intermediate users. The initiation of HACC use was significantly associated with (1) living in remote/inner/ regional areas, (2) being widowed or divorced, (3) having difficulty in managing income, (4) not receiving Veterans' Affairs benefits, (5) having chronic conditions, (6) reporting lower scores on the SF-36 health-related quality of life, and (7) poor/ fair self-rated health. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting.

Older women’s patterns of home and community care use and transition to residential aged care: An Australian cohort study

“…The HACC minimum datasets provided detailed information regarding quarterly usage of 28 service-types including domestic assistance, home maintenance, personal care, transport, centre-based day care, meal services, home modification, social care, counselling, care planning, and equipment and aids [7]. Patterns of HACC use were determined using k-median cluster analysis based on volume of each service used by participants over the study period [7,20]. The resultant clusters were labelled with different names and further categorized into two broad patterns/groups with 'basic or moderate HACC' and 'complex HACC' ( Table 1).…”

“…Selection of other predictor variables in the current study were guided by Andersen's health service utilization model and previous research [7,21]. The model categorizes individual/societal characteristics into three domains namely predisposing factors, enabling factors, and need factors.…”

“…Although this study provides significant insights into service outcomes of HCP, the participants were from only one HCP provider in New South Wales and Canberra, and were studied for a relatively small observation period. Furthermore, previous separate studies on HACC and RAC have reported that living in remote/rural areas is associated with increased odds of HACC use [7] but decreased risk of entering RAC [11]. Research is yet to explore whether high usage of HACC services reduce the risk of entering RAC.…”

“…The aged care system has been undergoing a significant reform following recommendations from the Productivity Commission [6]. Home and Community Care (HACC; now known as the Commonwealth Home Support Program (CHSP) is the largest aged care program in Australia which provides a range of entry-level care services to support older Australians living independently in their own home [7]. Of those who received aged care in 2017-18, around two-thirds (65%) used the CHSP https://doi.org/10.1016/j.maturitas.2019.10.004 Received 1 July 2019; Received in revised form 8 August 2019; Accepted 7 October 2019 T services, nearly a quarter (23%) entered RAC, and only 12% used home care packages (HCP) or transition care [8].…”

Housing and Care for Older Women in Australia

“…In this paper, we examine the interaction between housing pathways and care pathways for Australian women as they age from their 70's to their 90's, drawing on a wealth of data from the Australian Longitudinal Study on Women's Health (ALSWH). This population study has followed 12,432 women in the 1921-26 birth cohort for 25 years (to date), from when they were aged in their early 70's (in 1996) through to their late 90's, providing information on changes in women's health, housing, and use of health care and aged services (21,24). The women were randomly selected from the Australian universal health database (Medicare) and with oversampling of women living in rural and remote areas.…”