Naomi Davey, Marie Doyle, Alice O’Donoghue, Maggie Bolger, Barbara Murphy,
Millie O’Gorman, Suzanne Roche, Niamh Phelan, Stephanie Ryan, Jacinta Brennan,
Mairead O’Shea, Rudo Masombo, Stephen Whelan, Niamh O’Dwyer, Padraic McCarthy,
Padraig Bambrick, Robbie Bourke, Wail Binalialsharabi, Sinead Stoneman, George Pope,
Riona Mulcahy, John Cooke
University Hospital Waterford, Waterford, Ireland
Background: Our Age Related Care Unit houses a comprehensive patient database of
those patients referred to the specialist medicine for the older person service. The aim of
this study was to examine the provision of Home Care Packages (HCPs) and how this
relates to patient dependency. This analysis cannot be done using conventional HSE
KPIs for social care which tend to focus on resource consumption.
Methods: This is a retrospective analysis of all patients’ (1,087) first time visits to our
service from July 2017 to April 2018 with emphasis of those in receipt of a HCP.
Results: Frailty: Patients with a HCP had a median score of 6 (moderately frail) on the
Rockwood Clinical Frailty Scale in contrast to a median score of 4 (vulnerable) in those
without a HCP (p < 0.001).
Loneliness: 6.7% of patients (10) with a HCP identified themselves as feeling lonely
whereas 4.2% of patients (n = 19) without HCP self-identified as lonely.
Assessment tools: Barthel Score was 15 in those with HCP and 20 in those without (p
< 0.001). MOCA was 16/30 in those with a HCP and 19/30 in those without (p <
0.007). MMSE were similar in both groups (p = 0.273).
Population characteristics: BMI was 26 kg/m2 in those with a HCP and 27 kg/m2 in
those without. The mean age of those with and without HCP was 82 years old and 78
years old respectively (p < 0.001).
Conclusion: Our data indicate that, in an era of financial constraint, HCPs are being targeted
towards those with established frailty. All persons referred required specialist intervention
and therefore even those without an existing HCP should be considered a
vulnerable group. This is corroborated by cognitive testing and frailty assessments. These
patients are not being facilitated to live well at home and may be experiencing accelerated
functional decline as a result.