Fiona Keogh1, Maria Pierce2, Karen Neylon2, Padraic Fleming3, Laura Carter1,
Stephen O’Neill1, Eamon O’Shea1
1National University of Ireland Galway, Galway, Ireland
2Genio, Dublin, Ireland
3Health Service Executive, Dublin, Ireland
Background: An Intensive Home Care Package (IHCP) Initiative commenced in 2014
initially to reduce pressures on acute hospitals. Forming part of a process of strategic
realignment of the existing model of care towards home- and community-based care, it
also aimed to provide individualised supports to older people and their families that were
greater in range and level than existing services. The Initiative aligns with the Irish
National Dementia Strategy and the Integrated Care Programme for Older People.
Methods: A prospective cohort study was conducted using an administrative dataset,
collecting a suite of indicators informed by international literature and developed to
monitor and evaluate IHCPs. Data on the content and cost of IHCPs, and sociodemographic
characteristics of 505 IHCP recipients over the period December 2014 to
December 2017 was analysed.
Results: Of the 487 IHCP recipients with complete data, 60% were people with dementia
and 40% were people without dementia. The characteristics of recipients were: female
59%; mean age 78 years; married 51%; living alone 31%; high/maximum dependency
(Barthel Index) 83%; referred from acute hospital 65%. Compared to IHCP recipients
without dementia, those with dementia were on average, older, less dependent, and
received more hours of informal care before the IHCP commenced. Dementia IHCPs
had, on average, fewer formal support hours, and therefore lower mean costs per week.
Conclusion: This study provides evidence for the feasibility of discharging home from
acute hospital, people with high needs, with and without dementia, and supporting them
to remain at home. IHCPs offer an important addition to the currently limited menu of
support options for older people with complex needs. IHCPs appear to effectively target
those at highest risk of admission to long-stay residential care, and though not always less
costly than residential care, they are significantly less costly than an acute care bed.