Benefits of consumer directed home care short-lived, study finds

Consumer directed home care has quality of life benefits in the first year, but the effect appears to wear off, an exploratory study suggests.

The research published in the Australian Journal of Ageing in May investigated whether consumer directed care has improved the quality of life of older Australians who are receiving home care packages.

It compared two groups of people in receipt of CDC services from five providers across SA and NSW.

One group of 101 had been getting CDC for less than 12 months, and 49 others had been getting it for more than a year.  Respondents had a mean age of 83 and 67 per cent were women.

The research found that “older people with more recent exposure to CDC indicated a stronger capability to do things that made them feel valued”.

The data was collected between September 2016 and June 2017 during the early stages of CDC implementation.

Scant evidence

There’s currently little evidence about the impact of CDC on quality of life and findings from international studies are mixed, writes lead researcher Norma Bulamu from the Flinders Health and Medical Research Institute at Flinders University.

Her study measured health-related quality of life indicators including mobility, self care, usual activities, pain or discomfort and depression and anxiety using theEQ-5D-5L and ICECAP-O indexes.

Dr Bulamu says although there was no discernible impact on overall quality of life, there was evidence of improved choice and control under CDC.

“This study found that CDC has a positive impact as it promotes independence in terms of role functioning and older people feeling a sense of value, which fits with the underlying philosophy of CDC” she told Community Care Review.

The study didn’t find any difference in overall quality of life relating to the time people had been getting CDC services.

But it found who had been getting CDC for less than 12 months were more likely to report higher capability and being able to do things that made them feel valued than those who had been getting it for longer.

Dr Bulamu says there are a number of reasons for this, including people in the under-12 months group possibly being less frail and more optimistic.

Another reason could be that service providers were becoming better at providing CDC models of care and delivering a service that better met the needs of consumers than when they started. 

“It is also possible that over time the novelty of CDC had worn off and older people had become accustomed to the this model of care with no additional benefit to their self-reported quality of life,” she writes in the paper.

Being older, living alone and receiving fewer hours of care was also associated with a higher quality of life.

Dr Bulamu says more research is needed.

“Although this was a short exploratory study, longitudinal follow-up of older people’s quality of life is needed to track change over time and to determine the effectiveness of CDC in promoting improvements in quality of life,” she said. 

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