Using More End-of-Life Homecare Services is Associated With Using Fewer Acute Care Services: A Population-Based Cohort Study

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Background:Healthcare systems are investing in end-of-life homecare to reduce acute care use. However, little evidence exists on the timing and amount of homecare services necessary to reduce acute care utilization.Objectives:To investigate whether admission time to homecare and the amount of services, as measured by average nursing and personal support and homemaking (PSH) hours/week (h/wk), are associated with using acute care services at end-of-life.Research Design:Retrospective observational cohort study.Subjects:Decedents admitted to end-of-life homecare in Ontario, Canada.Measures:The odds ratios (OR) of having a hospitalization or emergency room visit in the 2 weeks before death and dying in a hospital.Results:The cohort (n = 9018) used an average of 3.11 (SD = 4.87) nursing h/wk, 3.18 (SD = 6.89) PSH h/wk, and 18% were admitted to homecare for <1 month. As admission time to death and homecare services increased, the adjusted OR of an outcome decreased in a dose response manner. Patients admitted earlier than 6 months before death had a 35% (95% CI: 25%–44%) lower OR of hospitalization than those admitted 3 to 4 weeks before death; patients using more than 7 nursing h/wk and more than 7 PSH h/wk had a 50% (95% CI: 37%–60%) and 35% (95% CI: 21%–47%) lower OR of a hospitalization, respectively, than patients using 1 h/wk, controlling for other covariates. Other outcomes had similar results.Conclusion:These results suggest that early homecare admission and increased homecare services will help alleviate the demand for hospital resources at end-of-life.

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