Hospitalizations and associated costs among older adults receiving regular home care services

Healthcare costs increase rapidly in aging societies. Research on service use is warranted in this context.

To examine predicting factors and costs associated with hospitalizations among home care clients aged ≥ 65 years.

Baseline data collection included demographic characteristics, diagnoses, morbidity (Charlson Comorbidity Index, CCI), basic and instrumental activities of daily living (BADL, IADL), Timed up and Go (TUG), Mini-Mental State Examination (MMSE) and health-related quality of life (EQ-5D-3 L). Univariate and multivariate logistic regressions were used to identify factors predicting hospitalization and gamma regression with a log link to analyze cumulation of inpatient days during one-year follow-up. Hospitalization costs were calculated using national unit costs of healthcare.

During follow-up, 176 (60%) of 293 regular home care clients were hospitalized. In univariate analyses, hospitalizations were statistically significantly associated with CCI, heart failure, peripheral vascular disease, renal failure, BADL, IADL and Eq. 5D3L. In multivariate analysis, only higher CCI (p = 0.008) predicted increased odds for hospitalization. Several diseases, number of medicines, BADL, IADL and MMSE were associated with inpatient days in univariate analyses. MMSE alone remained significant (p = 0.039) in multivariate analysis, higher scores predicted fewer days. Total hospitalization costs were €2,370,910, with €1,267,519 attributable to primary care and €1,103,391 to secondary care. Costs in the cohort were €9,225 per person-year.

Over half of regular home care clients required hospitalization with substantial costs during one year. Greater comorbidity burden predicted hospitalizations and cognitive impairment increased inpatient days.

Optimal disease management and maintenance of functioning should be prioritized in home care.