Funding community care for older adults: testing the applicability of the interRAI case mix in three New Zealand District Health Boards

interRAI;Resource Utilisation Groups;Community Care;RUGs;Case mix;Home Care;Older Adults

Heppenstall, Sally Ann ; Taylor, Will ; Keeling, Sally

University of Otago

关键词: interRAI;    Resource Utilisation Groups;    Community Care;    RUGs;    Case mix;    Home Care;    Older Adults;   

Others  :  https://ourarchive.otago.ac.nz/bitstream/10523/6121/1/HeppenstallSallyA2015MHealSc.pdf

美国|英语

来源: Otago University Research Archive

【 摘 要 】

Health policy makers internationally are tasked with determining how to support and fund increasing numbers of older people who are living longer with support needs to receive care in their own homes. Since 2012 it has been mandatory in New Zealand for people requiring publicly funded home and community support services or entry to residential care to have an interRAI assessment. Included in the interRAI methodology is a resource utilisation case mix system (RUG-III/HC).This study is the first small scale validation of this RUG case mix system within the New Zealand context. The objectives of the study were to show the extent to which the RUG categories predict the cost of support services and to examine if there are differences in this between three DHBS.Data was matched from interRAI Home Care (HC) v9.1 assessments completed in 3 DHBs (CCDHB, HVDHB and Wairarapa DHB) between 1 January and 30 June 2013, with payment data for home and community support services, namely personal cares, household management,carer support, residential respite and day care. A minimum of four weeks service was required for cases to be included in the sample. An analysis of variance model was used with the cost of support services as the dependent variable and the RUG category as the independent variable. Three separate ANOVA models were used for the cost of support services for formal costs, informal costs and combined formal and informal costs.The sample included 935 people with 71.7% from CCDHB, 19.8% from HVDHB and 8.5% from Wairarapa DHB. Explained variance of costs by RUG III categories was 17.8% for formal support services, 24.4% for informal support services and 29.6% for combined formal and informal support services. These proportions of explained variance are slightly lower than those found in two Canadian validation studies.RUG categories were found to predict informal support costs more accurately than they predict formal support costs. Wairarapa DHB showed a different pattern from the other two DHBs in the estimated marginal means of support services which suggests differences in how funded services are allocated.It is recommended that this study is repeated using data from all 20 DHBs in New Zealand in order to better understand such variation in the allocation of support services. Further research might also explore the possibility of devising bands of service cost for each of the RUG groups, taking into account whether the older person has informal support available or not. As has been suggested with comparable international RUG-III/HC validation studies further work is also required to differentiate the large proportion of people who fall into the lowest two RUG subcategories in the Reduced Physical Function RUG group.