1. Economic perspectives on the boundary of care for people with dementia in Ireland
- Author
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Carter, Laura, O’Shea, Eamon, and Hardiman Research Scholarship, National University of Ireland Galway
- Subjects
Business and Economics ,Business, Public Policy, and Law ,Economics ,costs ,Dementia ,residential care ,community care ,balance of care ,acute hospitals ,economic analysis ,informal care - Abstract
As the population ages, the expected increase in the number of people living with dementia will have significant budgetary implications on the health and social care system over the coming years. Therefore, from an economic standpoint, there is considerable incentive to make the best possible use of service provision for people with dementia in Ireland. The main focus in this thesis is the cohort of people with dementia who are on the margin of admission to residential care and/or acute care facilities. Keeping people with dementia at home, postponing admission to long-stay residential care (LSRC) and reducing length of stay (LOS) in acute care may yield significant cost savings for the Irish government, as well as enhance the quality of life for those affected. Reform is currently in train to shift care away from the acute and residential settings and towards the delivery of care at home, where appropriate. During that process, it is inevitable that policy-makers will face the complex task of identifying local needs, determining priorities, and allocating resources within a fixed budget constraint. The objective of this thesis is to inform resource allocation decision-making at key transition points for people with dementia in Ireland. The thesis uses a broad balance of care (BoC) framework to examine placement decision-making between home care and residential care and between acute care and home care, with the main emphasis on costs rather than outcomes. More specifically, this thesis seeks to support resource allocation at local and national levels and to address identified gaps in the literature relating to costs and, where possible, consequences of placement decision-making for people with dementia on the margins of home care, residential care, and acute care in Ireland. This thesis consists of three published papers completed over the past four years. The first paper analyses the cost of intensive home care packages (IHCPs) through an examination of resource utilisation of formal, informal, and private care for people with dementia who are living at home but are on the margin of LSRC. Importantly, this analysis facilitates the comparison between the cost of home care and alternative placement in public and private residential care alternatives. While the first study offers valuable insights into community care costs, it is important to consider factors that may affect transition towards LSRC and mortality for IHCP recipients, thereby enhancing our understanding of the specific characteristics of people who may benefit most from home-based care. For this reason, the second paper uses a competing risks survival analysis technique to examine predictors of admission to LSRC and mortality for IHCP recipients living at home who are on the boundary of residential care. Some people with dementia inevitably are admitted to acute care, and there is evidence that many of them spend a longer time as inpatients than might be reasonably expected, even when admitted for non-dementia reasons. The third paper considers the resource implications of dementia in the acute care setting and uses generalized linear modelling on a matched data set to estimate inpatient LOS for patients with a principal or secondary diagnosis of dementia in Irish acute hospitals. Related unit costs are estimated to give an overall additional cost of care for people with dementia in acute hospital settings. The thesis is a novel contribution to the Irish and international BoC empirical and policy literature, given the paucity of information currently available on costs and/or consequences of alternative care settings for people with dementia. This thesis has significant implications for the recalibration of care towards greater support of people with dementia living at home. The results of the three studies undertaken for the thesis will be particularly useful for the Department of Health to address current and future challenges in relation to placement decision-making for people with dementia in Ireland. The work has already impacted on the provision of home care packages for people with dementia and will help to shape the form and structure of new legislation on home care for people with dementia in the future.
- Published
- 2022