Abstract
The aims of the study were to describe (1) the need for help as well as the use and costs of services of home help and/or home nursing (home care) and (2) to identify the variables associated with the use and costs of health and social care services. A total of 721 Finnish home-care clients were interviewed in 2001. The need for help was assessed by basic and instrumental activities of daily Living (ADL) and in terms of pain and illness, rest and sleep, psychosocial well-being and social and environment variables. The Anderson–Newman model was used to study predictors of use of services, including visits of home-care personnel and visits to the doctor, nurse, physiotherapist, laboratory and hospital. Weekly costs of services were calculated. Data were analyzed using multivariate analyses. The clients had poor functional ability and they needed help at least once a week with, on average, 6 out of 15 ADL functions, and 5 out of 13 items relating to pain and illnesses, rest and sleep, psychosocial well-being and social and environment items. The enabling and need variables, particularly the variables “living alone” and “perceived need for help”, were important predictors for the use of services. Social care constituted more than half of the average weekly costs of municipalities. The perceived need for help with basic ADL was associated with higher costs. To ensure the quality of life among home-care clients while keeping costs reasonable is a challenge for municipalities.
Similar content being viewed by others
References
Algera M, Francke AL, Kerkstra A, van der Zee J (2004) Home-care needs of patients with long-term conditions: literature review. Integrative literature reviews and meta-analyses. J Adv Nurs 46(4):417–429
Andersen R, Newman J (1973) Societal and individual determinants of medical care utilization in the United Sates. Milbank Fund Q 51:95–124
Andersson MA, Clarke M, Helms L, Foreman M (2005) Hospital readmission from home health care before and after prospective payment. J Nurs Scholarsh 37(1):73–79
Annual reports of Kangasala and Kuopio municipalities in Finland, year 2001
Bond J, Dickinson HO, Matthews F, Jagger C, Brayne C (2006) Self-rated health status as a predictor of death, functional and cognitive impairment: a longitudinal cohort study. Eur J Ageing 3:193–206
Bruce M, McAvay G, Raue PJ, Brown E, Meyers B, Keohane D, Jagoda D, Weber C (2002) Major depression in elderly home health-care patients. Am J Psychiatry 159(8):1367–1374
Chang S-H, Chiu Y, Liou I-P (2003) Risks for unplanned hospital readmission in a teaching hospital in southern Taiwan. Int J Nurs Pract 9(6):389–395
Crets S (1996) Determinants of the use of ambulant social care by the elderly. Soc Sci Med 43(12):1709–1720
Divan S, Berger C, Manns EK (1997) Composition of the home-care service package: predictors of type, volume, and mix services provided to poor and frail older people. Gerontologist 37(2):169–181
Dunlop DD, Hughes SL, Manheim LM (1997) Disability in activities of daily living: patterns of change and a hierarchy of disability. Am J Public Health 87(3):378–383
Ellefsen B (2002) Dependency as disadvantage—patients’ experiences. Scand J Caring Sci 16:157–164
Finne-Soveri H, Björkgren M, Vähäkangas P, Noro A (eds) (2006) Kotihoidon asiakasrakenne ja hoidon laatu - RAI-järjestelmä vertailukehittämisessä. (Quality and case-mix among elderly clients in home care. Benchmarking with RAI) STAKES, Helsinki, Finland
Fortinsky R, Fenster J, Judge J (2004) Medicare and medicaid home health and medicaid waiver services for dually eligible older adults: risk factors for use and correlates of expenditures. Gerontologist 44(6):739–749
Geerlings S, Pot A, Twisk J, Deeg D (2005) Predicting transitions in the use of informal and professional care by older adults. Ageing Soc 25:111–130
Gitlin L, Mann W, Tomit M, Marcus S (2001) Factors associated with home environmental problems among community-living older people. J Disabil Rehabil 23(20):777–787
Grimmer K, Moss J, Falco J (2004) Experience of elderly patients regarding independent community living after discharge from hospital: a longitudinal study. Int J Qual Health Care 16(6):465–472
Hammar T, Perälä M-L, Rissanen P (2007) The effects of integrated home care and discharge practice on functional ability and health-related quality of life: a cluster-randomised trial among home-care patients. Int J Integr Care 27:1568–4156
Hammar T, Raatikainen R, Perälä M-L (1999) Sosiaali- ja terveyspalvelut tulevaisuudessa: 60–65-vuotiaiden odotukset palveluista 80-vuotiaana. (Social and health-care services in the future: 60–65 years old inhabitants’ expectation of services as 80 years old). Gerontologia 13(4):189–199
Hellström Y, Persson G, Hallberg IR (2004) Quality of life and symptoms among older people living at home. JAdv Nurs 48(6):584–593
Hellström Y, Hallberg I (2001) Perspectives of elderly people receiving home help on health care and quality of life. Health Soc Care Community 9(2):61–71
Hollander M, Chappell N, Havens B, McWilliam C, Miller JA (2002) Study of the costs and outcomes of home care and residential long-term care services. Substudy 5. A report prepared for the Health Transition Fund, Health Canada. http://www.homecarestudy.com
Hujanen T (2003) Terveydenhuollon yksikkökustannukset Suomessa vuonna 2001. (Unit cost of health care service in Finland 2001) STAKES, Themes 1, Helsinki, Finland
Unit cost of health-care services in Finland 2001(2003) STAKES, Aiheita
Jacobs P (2001) Costs of acute care and home-care services. Substudy 9. A report prepared for the Health Transition Fund, Health Canada. http://www.homecarestudy.com
Janlöv AC, Hallberg IR, Petersson K (2005) The experience of older people of entering into the phase of asking for public home help—a qualitative study. Int J Soc Welfare 14:326–336
Jylhä M (1985) Oman terveyden kokeminen eläkeiässä. (Self-perceived health of the elderly) Acta Universitatis Tamperensis ser A vol 195. Doctoral thesis, University of Tampere, Tampere, Finland
Kadushin G (2004) Home health-care utilization: a review of the research for social work. Health Soc Work 29(3):219–248
Kauppinen S, Forss A, Säkkinen A, Voutilainen P, Noro A (eds) (2003) Ikääntyneiden sosiaali-ja terveyspalvelut 2002. Suomen virallinen tilasto (SVT) [Care and services for older people 2002. Official Statistics of Finland, (SVT)]. STAKES, Helsinki, Finland (in Finnish, English and Swedish)
Kvaal K, Laake K (2003) Anxiety and well-being in older people after discharge from hospital. J Adv Nurs 44(3):271–277
Kvaal K, Macijauskiene J, Engedal K, Laake K (2001) High prevalence of anxiety symptoms in hospitalized geriatric patients. Int J Geriatr Psychiatry 16:690–693
Larsson K, Thorslund M, Kårenholt I. (2006) Are public care and services for older people targeted according to need? Applying the Behavioural Model on longitudinal data of a Swedish urban older population. Eur J Ageing 3:23–33
Larsson K, Silverstein M (2004) The effects of marital and parental status on informal support and service utilization: a study of older Swedes living alone. J Aging stud 18:231–244
Laukkanen P, Karppi P, Heikkinen E, Kauppinen M (2001) Coping with activities of daily living in different care settings. Age Ageing 30:489–494
Lee TT, Mills ME (2000) Analysis of patient profile in predicting home care resource utilization and outcomes. J Nurs Adm 30(2):67–75
Modin S, Furhoff AK (2002) Care by general practitioners and district nurses of patients receiving home nursing: a study from suburban Stockholm. Scand J Prim Care 20:208–212
Modin S, Furhoff AK (2004) The medical care of patients with primary care home nursing is complex and influenced by non-medical factors: a comprehensive retrospective study from a suburban area in Sweden. BMC Health Services Research 4(22). http://biomedcentral.com/1472-6963/4/22
National Research and Development Centre for Social Welfare and Health (2000) The Finnish care registers for social and welfare and health (HILMO). STAKES, Helsinki, Finland
Noro A, Häkkinen U, Laitinen O (1999) Health services research. Determinants of health service use and expenditure among the elderly Finnish population. Eur J Public Health 9:174–180
Noro A (1998) Long-term institutional care among Finnish elderly population. Trends and potential for discharge. STAKES, research report 87. Doctoral thesis, Gummerus Kirjapaino Oy, Jyväskylä, Finland
OECD (Organisation for economic co-operation and development) Reviews of Health Systems. Finland. OECD 2005. STAKES, Helsinki, Finland
Patel A (2006) Conducting and interpreting multi-national economic evaluations: the measurement of costs. In: Curtis L, Netten A (eds) Unit costs of health and social care. Personal Social Services Research Unit, University of Kent, UK, pp 9–22. http://www.pssru.ac.uk/uc/uc2006contents.htm
Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23(10):433–441
The Primary Health Care Act 66/1972, Helsinki, Finland (in Finnish). Accessed http://www.finlex.fi/fi/laki/ajantasa/1972/19720066
Population Statistics, Statistics Finland (2004)
Pot A, Deeg D, Twisk J, Beekman A, Zarit S (2005) The longitudinal relationship between the use of long-term care and depressive symptoms in older adults. Gerontologist 45:359–369
Rannhoff AH (1997) Activities of daily living, cognitive impairment and other psychological symptoms among elderly recipients of home help. Health Soc Care Community 5:147–152
Rannhoff AH, Laake K (1995) Health and functional among elderly recipients of home help in Norway. Health Soc Care 3:115–123
Rasbash J, Browne W, Goldstein H, Yang M, Plewis I, Healy M, Woodhouse G, Draper D, Langford I, Lewis T (2001) A user’s guide to MLwin. Version 2.1c. Centre for Multilevel Modelling, Institute of Education, University of London, UK
Ikääntyvien potilaiden hoito- ja kotiuttamiskäytännöt. Rekisteripohjainen analyysi aivohalvaus-ja lonkkamurtumapotilaista (1999) In: Rissanen P, Noro A (eds) Hospital care and discharge practices of elderly patients—register-based analysis. STAKES, Themes 44, Helsinki, Finland.
Rissanen P (1996) Effectiveness, costs and cost-effectiveness of hip and knee replacements. STAKES, Research report 64 (doctoral thesis) Gummerus Kirjapaino Oy, Jyväskylä, Finland
Roper N, Logan W, Tierney AJ (2000) The Roper Logan Tierney. Model of nursing. Based on activities of living. Churchill Livingstone, London
Räty T, Luoma K, Mäkinen E, Vaarama M (2003) The factors affecting the use of elderly care and the need for resources by 2030 in Finland. Governments Institute for Economic Research (VATT) -research reports 99. Oy Nord Print Ab, Helsinki, Finland
Smith A, Carusone S, Willison K, Babineu T, Smith SD, Abernathy T, Marrie T, Loeb M (2005) Hospitalization and emergency department visits among seniors receiving homecare: a pilot study. BMC Geriatr 5:9. http://www.biomedcentral.com/1471-2318/5/9
Sotka -municipal database for social and health statistics in Finland, year 2000. Accessed http://uusi.sotkanet.fi/portal/page/portal/etusivu (in Finnish and English)
Statistical summary (2007) Dementia-asiakkaat sosiaali- ja terveyspalvelujen piirissä 2001, 2003 ja 2005 (Clients with dementia in health and social services, years 2001, 2003 and 2005) Tilastotiedote 20/2007, STAKES. http://www.stakes.fi/tilastot/dementia [in Finnish]
The Status and Right of Social Welfare Clients 812/2000, Helsinki, Finland. Accessed http://www.finlex.fi/fi/laki/ajantasa/2000/20000812 (in Finnish)
Thome’ B, Dykes AK, Hallberg I (2003) Home care with regard to definition, care recipients, content and outcome: systematic literature review. J Clin Nurs 12(6):860–872
Vaarama M (2004) Ikääntyneiden toimintakyky ja hoivapalvelut - nykytila ja vuosi 2015. Teoksessa: Valtioneuvoksen kanslia. Ikääntyminen voimavarana. Tulevaisuusselonteon liiteraportti 5. Valtioneuvoston kansalian julkaisusarja 33/2004. Valtioneuvoston kanslia, Helsinki. (The functional ability and services of the aging people—the present situation and year 2015. Prime Minister’s Office publications 33/2004, Helsinki]
Van Campen C, van Gameren E (2004) Eligibility for long-term care in The Netherlands: development of a decision support system. Health Soc Care Community 13(4):287–296
Van Campen C, Woittiez I (2003) Client demand and the allocation of home care in the Netherlands. A multinomial logit model of client types, care needs and referrals. Health Policy 64:229–241
Van Gameren E, Woittiez I (2005) Transitions between care provisions demanded by dutch elderly. Health Care Manage Sci 8:299–313
Voutilainen P, Vaarama M (2005) Toimintakykymittareiden käyttö ikääntyneiden palvelutarpeen arvioinnissa. Stakes raportteja 7/2005. (Use of measures of functional ability in the assessment of service needs among older people. STAKES, reports 7/2005]
Wallace DC, Hirst PK (1996) Community-based service use among the young, middle, and old. Public Health Nurs 13(4):286–293
Waters K, Allsopp D, Davidson I, Dennis A (2001) Sources of support for older people after discharge from hospital: 10 years on. J Adv Nurs 33(5):575–82
World Health Organization (2001) International classification of functioning, disability and health (ICF). WHO, Geneva. www3.who.int/icf/icftemplate.cfm
Acknowledgments
This study was supported by the Development Centre for Welfare and Health (STAKES) and doctoral programmes in public health at the Helsinki and Tampere universities.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hammar, T., Rissanen, P. & Perälä, ML. Home-care clients’ need for help, and use and costs of services. Eur J Ageing 5, 147–160 (2008). https://doi.org/10.1007/s10433-008-0078-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10433-008-0078-4