Hospitalizations and Associated Costs Among Older Adults Receiving Regular Home Care Services

Background This was a prospective one-year follow-up study. Participants (n=293) were persons aged ≥65 years living in Eastern Finland and receiving regular home care services. Aims To examine factors, diagnoses, and costs associated with hospitalizations among home care clients Methods Baseline examination encompassed comprehensive information on clients’ demographic characteristics, morbidity as measured by the Charlson Comorbidity Index (CCI), current pharmacological treatments, and functional assessments. Binary logistic regression was used to assess factors predicting hospitalization and linear regression to assess factors predicting the number of inpatient days. The costs of hospitalizations were calculated using the national unit costs of health care. Results A total of 176 (60%) home care clients were hospitalized at least once during the follow-up. A higher CCI (OR 1.26, CI95% 1.10-1.45), lower BADL (0.71, 0.59-0.89) and IADL scores (0.81, 0.72-0.92), longer TUG times (1.02, 1.00-1.03), and lower HRQoL (0.25, 0.09-0.71) were associated with hospitalizations. Cognitive and functional impairment increased the number of inpatient days. The total costs of hospitalizations were €2,370,910, with primary care accounting for €1,267,519 and secondary care €1,103,391 of the costs. In the entire cohort, the costs amounted to €9,225 per person-year. Discussion Despite regular home care services, over half of the home care clients were hospitalized with substantial costs in one-year timeframe. Greater comorbidity burden, functional impairment and lower health-related quality of life predicted hospitalizations, while cognitive impairment was associated with increased inpatient days. Conclusions Besides optimal disease management, preserving functioning of the clients is a critical component of home care.