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Resources and Costs Associated with Disabilities of Elderly People Living at Home and in Institutions*

Published online by Cambridge University Press:  29 November 2010

Réjean Hébert
Affiliation:
Sherbrooke Geriatric University Institute University of Sherbrooke.
Nicole Dubuc
Affiliation:
Sherbrooke Geriatric University Institute University of Sherbrooke.
Martin Buteau
Affiliation:
Sherbrooke Geriatric University Institute University of Sherbrooke.
Johanne Desrosiers
Affiliation:
Sherbrooke Geriatric University Institute University of Sherbrooke.
Gina Bravo
Affiliation:
Sherbrooke Geriatric University Institute University of Sherbrooke.
Lise Trottier
Affiliation:
Sherbrooke Geriatric University Institute
Carole St-Hilaire
Affiliation:
Sherbrooke Geriatric University Institute
Chantale Roy
Affiliation:
University of Sherbrooke.

Abstract

This study was carried out on a representative sample of elderly people living at home (n = 300), in intermediate faculties (n = 271) and nursing homes (n = 774) from metropolitan, urban and rural areas in the Province of Quebec (Canada) in order to: 1) determine the level of disabilities and resources involved in the care of elderly people living at home or in institutional settings; 2) estimate the costs (public, private, voluntary) of these resources; 3) compare the costs according to the level of disability; and 4) predict the costs associated with disabilities. Results show that there were significant differences but large overlap in the disability level, cognitive status and nursing care needed and received between participants from the three settings. The disability score explained 85 per cent of the variance in nursing care time and 55 per cent (home), 15 per cent (intermediate facilities) and 68 per cent (nursing homes) of the variance in the cost. Nursing care was responsible for most of the cost in all settings. The total societal cost of home care was greater than the cost of intermediate facilities for elderly participants with a disability score over 7.4 and greater even than the cost of nursing homes for a score over 38.7.

Résumé

Cette étude a été réalisée auprès d'un échantillon représentatif de sujets âgées vivant à domicile (n = 300), dans des ressources de type familial (RTF) ou des pavilions (n = 271) et dans des institutions d'hébergement (n = 774) de zones métropolitaine, urbaines et rurales du Québec afin de: 1) déterminer le niveau d'incapacité et les ressources consacrés aux soins des personnes âgées vivant à domicile ou en institution; 2) estimer les coûts (publics, privés et bénévoles) de ces ressources; 3) comparer les coûts à autonomie égale; 4) prédire les coûts selon le niveau d'incapacité. Les principaux résultats montrent que les sujets des trois milieux de vie présentent des différences significatives quant au niveau d'incapacité, à l'état cognitif et aux soins requis et fournis, bien que des chevauchements importants étaient notables. Le score d'incapacité explique 85 pour cent de la variance du temps de soins ainsi que, respectivement, 55, 15 et 68 pour cent des coûts à domicile, en RTF et pavilions et en institutions. Les soins infirmiers et d'assistance sont responsables de la majorité des coûts dans tous les milieux de vie. Le coût social total des soins à domicile étaient plus élevé que ceux en RTF et pavilions pour les sujets avec un score d'incapacité de 7,4 et plus et même supérieur à ceux en institutions pour un score au-dessus de 38,7.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2001

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References

Atkinson, A, Banker, R, Kaplan, R, & Young, SM. (1992). Management accounting. 2nd edition. Scarborough: Prentice Hall.Google Scholar
Bachelard, B, & Jeanpêtre, N. (1986). Tous les coûts sont-ils permis? Coût, financement et planification: Expérience pilote de renforcement de l'action médico-sociale dans le canton de Vaux. Lausanne: Service cantonal de recherche et d'information statistique.Google Scholar
Bellerose, C, Lavallée, C, Chénard, L, & Levasseur, M. (1992). Santé Québec: Et la santé, ça va en 1992–1993? Montréal, Ministère de la Santé et des Services sociaux.Google Scholar
Bouget, D, Tartarin, R, Frossard, M, & Tripier, P. (1990). Le prix de la dépendance: comparaison dee dépenses des personnes âgées selon leur mode d'hébergement. Paris: Caisse nationale d'assurance-vieillesse des travailleurs salariés.Google Scholar
Bravo, G, & Hébert, R. (1997). Age and education-specific reference values for the Mini-Mental and Modified Mini-Mental State Examinations derived from a non-demented elderly population. Int J Geriat Psychiatry, 12, 10081018.3.0.CO;2-A>CrossRefGoogle ScholarPubMed
Burns, RL, Lamb, GS, & Wholey, DR. (1996). Impact of integrated community nursing services on hospital utilization and costs in a medical risk plan. Inquiry, 33, 3041.Google Scholar
Canadian Study on Health and Aging Working Group. (1994). Canadian Study on Health and Aging: study methods and prevalence of dementia. Can Med Assoc J, 150, 899913.Google Scholar
Carpenter, GI, Main, A, & Turner, GF. (1995). Case-mix for the elderly inpatient: resource utilization groups (RUGs) validation project. Age Ageing, 24, 513.CrossRefGoogle ScholarPubMed
Challis, D, Darton, R, Johnson, L, Stone, M, & Traske, K. (1991). An evaluation of an alternative to long-stay hospital care for frail elderly patients: Part II. Costs and effectiveness. Age and Ageing, 20, 245254.CrossRefGoogle Scholar
Cumming, JE, & Weaver, FM. (1991). Cost-effectiveness of home care. Clinics in Geriatric Medicine, 7(4), 865874.CrossRefGoogle Scholar
Demers, A, Lavoie, JP, & Drapeau, A. (1992). Support provided by third parties and the reaction of close female caregivers in the care of elderly persons with loss of autonomy. Santé mentale au Québec, 17, 205225.CrossRefGoogle ScholarPubMed
Desrosiers, J, Bravo, G, Hébert, R, & Dubuc, N. (1995). Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research. Age Ageing, 24, 402406.CrossRefGoogle ScholarPubMed
Disler, PB, Roy, CW, & Smith, BP. (1993). Predicting hours of care needed. Arch Phys Med Rehabil, 74, 139143.Google ScholarPubMed
Dubuc, N, Desrosiers, J, Bravo, G, & Hébert, R. (1996). Fidélité de la détermination des services requis en termes d'eures par le CTMSP modifié à des fins de recherche épidémiologique. L'année gérontologique, 10, 8395.Google Scholar
Ennuyer, B. (1987). Prix de revient et coüts respectifs du maintien à domicile et de l'hébergement: enjeux financiers, économiques, politiques et … philosophiques. Gérontologie et Société, 39, 6170.Google Scholar
Folstein, MF, Folstein, SE, & McHugh, PR. (1975). “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res, 12, 189198.CrossRefGoogle ScholarPubMed
Fries, BE, Schneider, DP, Foley, WJ, Gavazzi, M, Burke, R, & Cornelius, E. (1994). Refining a case-mix measure for nursing homes: resource utilization groups (RUG-III). Medical Care, 32, 668685.CrossRefGoogle ScholarPubMed
Harrow, BS, Tennstedt, SL, & McKinlay, JB. (1995). How costly is it to care for disabled elders in a community setting? The Gerontologist, 35(35), 6813.CrossRefGoogle Scholar
Hébert, R, & Bilodeau, A. (1986). Profil d'autonomie fonctionnelle de personnes âgées en institution. Cahiers de l'ACFAS, 46, 6679.Google Scholar
Hébert, R, Bravo, G, & Girouard, D. (1992). Validation de l'adaptation française du Modified Mini-Mental State (3MS). Revue de gériatrie, 17(8), 443450.Google Scholar
Hébert, R, Bravo, G, Korner-Bitensky, N, & Voyer, L. (1996). Refusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects. J Clin Epidemiol, 49, 373381.CrossRefGoogle ScholarPubMed
Hébert, R, Brayne, C, & Spiegelhalter, D. (1997). Incidence of functional decline and improvement in a community-dwelling, very elderly population. Am J Epidemiol, 145, 935944.CrossRefGoogle Scholar
Hébert, R, Carrier, R, & Bilodeau, A. (1988a). Le système de mesure de l'autonomie fonctionnelle (SMAF). Revue degériatrie, 13(13), 4167.Google Scholar
Hébert, R, Carrier, R, & Bilodeau, A. (1988b). The functional autonomy measurement system (SMAF): Description and validation of an instrument for the measurement of handicaps. Age Ageing, 17, 293302.CrossRefGoogle ScholarPubMed
Hébert, R, Dubuc, N, Buteau, M, Roy, C, Desrosiers, J, Bravo, G, et al. (1997). Services requis par les personnes âgées en perte d'autonomie: évaluation clinique et estimation des coûts selon le milieu de vie. Collection Études et analyses no 33. Québec: Ministère de la Santé et des Services sociaux.Google Scholar
Hébert, R, Spiegelhalter, D, & Brayne, C. (1997). Setting the minimal metrically detectable change on disability rating scales. Arch Phys Med Rehabil, 78, 13051308.CrossRefGoogle ScholarPubMed
Hornbrook, MC. (1989). Nursing home case-mix measurement. In Peterson, MD & White, DL (Eds.), Health care of the elderly (pp. 206276). Newbury Park: Sage Publications.Google Scholar
Kemper, P. (1992). The use of formal and informal home care by the disabled elderly. Health Services Research, 27(4), 421451.Google ScholarPubMed
Livingston, G, Manela, M, & Katona, C. (1997). Cost of community care for older people. Br J Psychiatry, 171(7), 5659.CrossRefGoogle ScholarPubMed
Max, W, Webber, P, & Fox, P. (1995). Alzheimer's disease, the unpaid burden of caregiving. Journal of Aging and Health, 7(2), 179199.CrossRefGoogle Scholar
McDowell, I, Kristjansson, B, Hill, GB, & Hébert, R. (1997). Community screening for dementia: The Mini-Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. J Cli Epidemiol, 50(4), 337383.Google ScholarPubMed
McKinley, JB, Crawford, SL, & Tennstedt, SL. (1995). The everyday impact of providing informal care to dependant elders and their consequences for the care recipients. J Aging Health, 7(4), 497528.CrossRefGoogle Scholar
McNamee, P, Gregson, BA, Buck, D, Bamford, CH, Bond, J, & Wright, K. (1999). Cost of formal care for frail older people in England: the resource implications study of the MRC cognitive function and ageing study (RIS MRC CFAS). Soc Science Med, 48, 331341.CrossRefGoogle ScholarPubMed
Moscovice, I, Davidson, G, & McCaffrey, D. (1988). Substitution of formal and informal care for the community-based elderly. Medical Care, 26(10), 971981.CrossRefGoogle ScholarPubMed
O'Shea, E, & Blackwell, J. (1993). The relationship between the cost of community care and the dependency of old people. Soc Sci Med, 37(5), 583590.CrossRefGoogle ScholarPubMed
Rheault, S. (1994). L'évaluation économique des modes d'hébergement pour les personnes âgées en perte d'autonomie: recension des méthodes et des résultats. Québec: Gouvernement du Québec.Google Scholar
Rochon, M. (1993). Impact des changements démographiques sur l'évolution des dépenses publiques de santé et de services sociaux. (Collection Études et analyses #21). Québec: Gouvernement du Québec, Ministère de la Santé et des Services sociaux, Direction générale de la planification et de l'évaluation.Google Scholar
Saucier, A. (1992). Le portrait des personnes ayant des incapacités au Québec en 1986. Québec: Ministère de la Santé et des Services sociaux, Direction de l'évaluation.Google Scholar
Teng, EL, & Chui, HC. (1987). The modified Mini-Mental State (3MS) Examination. J Clin Psychiat, 48, 314318.Google ScholarPubMed
Tennstedt, SL, McKinlay, JB, & Sullivan, LM. (1989). Informal care for frail elders: The role of secondary caregivers. The Gerontologist, 29(5), 677683.CrossRefGoogle ScholarPubMed
Thornton, C, Dunstan, SM, & Kemper, P. (1988). The effect of channeling on health and long-term care costs. Health Services Research, 23(1), 130142.Google ScholarPubMed
Tilquin, C, Michelon, P, D'Hoore, W, Sicotte, C, Carillo, T, & Léonard, G. (1995). Using the handicap code of the ICIDH for classifying patients by intensity of nursing care requirements. Disability and Rehabilitation, 17, 176183.CrossRefGoogle ScholarPubMed
Tilquin, C, Pineault, R, Sicotte, C, & Audette, LM. (1977). Administration d'unréseau de services socio-sanitaires pour les personnes âgées. Administration hospitalière et sociale, mai-juin, 2632.Google Scholar
Tilquin, C, Vanderstraeten, G, Fournier, J, St-Onge, E, Toupin, J, & Lambert, P. (1984). La systématisation des procédures d'admission des personnes âgées dans les établissements et les programmes de soins et services intermédiaires et à domicile. In Van Eimeren, V & Engerlbrecht, R (Eds.), Third International Conference on System Science in Health Care (pp. 194198). Berlin: Springer-Verlag.CrossRefGoogle Scholar
Turner, GF, Main, A, & Carpenter, GI. (1995). Case-mix, resources use and geriatric medicine in England and Wales. Age Ageing, 24, 14.CrossRefGoogle ScholarPubMed
Weissert, WG, Matthews, CC, & Pawelak, JE. (1988). The past and the future of home and community-based long-term care. The Milbank Quarterly, 66(2), 309388.CrossRefGoogle ScholarPubMed
World Health Organization. (1980). International Classification of Impairments, Disabilities, and Handicaps: A manual of classification relating to the consequences of disease. Geneva: WHO.Google Scholar