Vet Affairs vs HCP Outcomes?
3 minute read
and the winner is….
In a dramatic research finding, more than twice as many home care package clients are progressing to residential care compared to people who get Vet’s Affairs support. While the programs provide different levels and types of support, the findings could provide significant insight into the best future approaches for home care success.
A recent University of Sydney analysis compared the outcomes for over 65 year olds using Home Care Packages (HCPs) versus those accessing Veterans’ Affairs Community Nursing (VCN). The VCN program is funded by the Department of Veterans’ Affairs and is available to Veterans Gold Card holders and some Veteran White Card holders. HCP is available to all older people living in the community who are referred and meet eligibility criteria.
The retrospective study of over 40,000 older people found that within five years of accessing services, 58 percent of home care package clients had been admitted to an aged-care home, compared with only 27 percent of Vet’s Affairs clients. That is a huge difference in outcomes.
Lead author Professor Yun-Hee Jeon said two of the key differences in the delivery of the Veterans’ Affairs program were a short time to referral and the role of registered nurses. She noted the Veterans’ program is led and mostly delivered by registered nurses, based on a care plan developed by the registered nurse’s comprehensive assessment, with a very short wait time from a referral. Another significant difference is that the veterans’ program is set up to be accessed periodically as needed, whereas HCP clients tend to retain their service until they die or go into care.
Professor Jeon said that numerous conversations with service providers and clinicians suggest that participants in the Veterans' program had a mindset of ‘letting it go’ because they were confident they would be able to access the service again next time they needed it, for example after a fall or bad health spell. By comparison, home care clients do not let services go even if their needs decrease, as they are well aware of the 6- to-18 month waiting period for services.
The study included economic analysis that found that, for VCN compared to HCP clients, the estimated cost-saving over five years was over $1 billion. The cost savings largely resulted from preventing or delaying aged care home admission which equates to over $90k per person per year. Importantly, the research also showed significant cost savings would be made even if the VCN program cost was increased in line with the HCP.
The longer older people live in the community, the higher their quality of life and the lower the cost to government. As such, delaying or preventing care home admission by providing the right support has long been an important policy goal, as emphasised again in the recent report from the Aged Care Taskforce..
Professor Yun Hee Jeon agreed with Taskforce recommendations that more emphasis needed to be placed on ‘health related care’ in aged care services and delivery in a timely manner to enable people to remain at home longer. However, she said all reform initiatives proposed to date have glossed over the importance of skilled professionals such as registered nurses and allied health professionals for optimising outcomes.
“Using the broad term ‘aged care workforce’ rather than differentiating the skill sets, roles and responsibilities under this umbrella term is not always helpful. It can easily dismiss profession-specific issues that need addressing to ensure quality aged care. It also overlooks challenges with attracting and retaining health professionals which are often significantly different from those of other care workers in the sector”.
“Older persons’ care requires comprehensive assessment by skilled clinicians and planned care based on individual needs, considering available resources and circumstances. The current model forces health care professionals to focus on ‘tasks’ and ‘tick boxes’, rather than using critical thinking and clinical judgement. “Furthermore, the current HCP assessment is for determining eligibility and levels of care for an allocation of funds. By the time the allocated care is available six months later, that person's care needs have likely changed.”
She said by comparing two existing models of community care, this research highlights the importance of timely care and support from a skilled nursing workforce.
While the paper suggests further economic analysis is needed, Professor Jeon said the research team have confidence in the findings due to the large sample size of this first-of-its-kind study and analyses that considered the cost of the VCN program, the length of stay in residential care and the distribution of HCP types.
* The opinions expressed within this article are those of the people who are quoted and do not represent the Department of Veterans Affairs or any other organisation.
You can find the full study paper here
Prof. Yun-Hee Jeon is speaking at the National Home Care Conference 2024, which takes place on 30-31 May at Marvel Stadium, Melbourne and online
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