Frail Elderly Home Care Clients: the Effects and Expense of Adding Nursing Health Promotion and Preventive Care to Personal Support Services

Abstract

<p>Objectives: • Develop, implement and evaluate a new model for delivering services to frail seniors, focusing on health promotion and preventive care provided by a Registered Nurse within the context of home care services. • Provide information on the health outcomes and costs associated with existing policies regarding the provision of preventive home care services for frail seniors living at home. • Provide scientific support for the role of a Registered Nurse in health promotion and preventive care within the context of home care services. Intervention: Proactive health promotion and preventive care provided by a Registered Nurse for frail elderly home care clients eligible for personal support services. The intervention consisted of a minimum of one contact (primarily home visits) per month by an RN over a 6-month period. Research Design: Randomized controlled trial with baseline (pre-randomization) and 6 month follow-up and outcome assessment. Sample and Setting: 94 individuals (44 experimental, 50 controls) 75 years and older newly referred to and eligible for personal support services through a home care programme in Southern Ontario, Canada. Results: Clinically and statistically significant improvements in physical and mental health functioning and increased level of perceived social support for clients was associated with the study intervention at no additional expense from a societal perspective. There was an economically important difference in the use of acute hospitalization in the intervention group compared to usual care which translates into an annual cost saving of $200,879 within 1 year for every 100 elderly home care clients. Implications: Under the current home care delivery system, this study demonstrates that it is more effective and no more expensive to provide proactive RN health promotion to a general population of frail seniors than to provide professional services on a reactive and piecemeal basis.</p>