The object of this research is to examine how different subsets of patients use publicly funded home care services. Identification of those patient characteristics that are associated with relatively expensive charges for home care is fundamental to future policies regarding which types of patients are best served in this setting, and how such care should be reimbursed.
The specific aim of this retrospective cohort study is to compare the public costs incurred for providing home care services to low income, elderly patients who are increasingly dependent in toileting relative to those that are independent. Hypotheses will be tested using analysis of variance and multivariate analysis to determine if those dependent in toileting generate higher costs of formal home care and to identify the pattern of use of home call services associated with increasing levels of disability. Previous research has demonstrated that dependence in urinary functioning generates additional direct daily expenses in terms of labor and supplies, however, this research has indirectly estimated costs and has been focused primarily on nursing home populations. Less is known about how those dependent in toileting use home cae services over time. This research makes a unique contribution because extensive patient specific baseline assessment data will be linked with five years of actual bill files yielding a complete picture of all publicly funded home care services received by a cohort of community living elders. The nature of the data thus makes is possible to compare the experience of patients with increasing dependence in activities of daily living across programs and over time.
