Targeting frail older people at home to prevent admission to residential care: a case-mix study

Background: Older people usually prefer staying at home rather than going into residential care. The Belgian National Institute for Health and Disability Insurance wishes to invest in home care by financing innovative projects that effectively help older people to stay at home longer. In this study protocol we describe the evaluation of 64 home care projects. These projects are clustered according to the type of their main intervention such as case management, day care, night care, occupational therapy at home and psychological/psychosocial support. The main goal of this study is to identify which types of projects have the most effect in delaying institutionalization of frail older persons.Methods/design: This is a longitudinal intervention study based on a quasiexperimental design. Researchers use two comparison strategies to evaluate intervention - comparison between older persons receiving the interventions and older persons who are still at home but who do not receive any intervention and between older persons in the study population and older persons who are going into residential care. Projects are asked to include clients who are frail and at risk of institutionalization. In the study we use internationally validated instruments such as the interRAI Home Care instrument and the Zarit Burden Interview-12. These instruments are filled out at baseline, at exit from the project and 6 months after baseline. Additionally, caregivers have to do a follow-up every 6 months until exit from the project. Criteria to exit the cohort will be institutionalization longer than 3 months and death. The main analysis in the study consists of the calculation of the relative risk of definitive institutionalization.Discussion: This research will provide knowledge on the functional status of frail older persons who are still living at home. This is important information in order to characterize the population at risk of institutionalization, as well as to explore the determinants for informal caregivers’ burden. The identification of effective home care interventions in delaying institutionalization will be useful to inform and empower home care providers, policy and related decision makers to manage and improve home care services.Research protocol: Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting.

LG VB KF