Buying Time for Better Decision-Making: The Impact of Home Based Re- habilitation on Frail Older People

Often, life-changing decisions regarding the long-term care needs of frail older patients are taken at vulnerable times when they are ill or hospitalized. Consequently, patients may be placed inappropriately in institutional care where it is difficult to regain the skills or confidence needed to return home. This paper presents findings from an evaluation of a service that extends the period of decision making about patients needs by providing a rehabilitative package of care in the patient’s own home. Participants comprised two groups; older people who received the rehabilitation service (n=56) and a comparator group of similar older people who received a care managed service (n=56). All participants completed a series of measures at three time-points. These measures included an assessment of functioning, a measure of quality of life and, a measure of service utilization. On discharge, rehabilitation clients experienced significant improvements relative to caremanaged clients on all functional measures (FIM, P=.014; CDI, P=.001; EASY, P=.001); quality of life (P=.003); and, service utilization and cost (P=.001). In addition, carers of rehabilitation service users reported significantly less stress than carers of care-managed patients (P=.007). These results show that the rehabilitation service succeeded in improving functioning and helped to create a longer time-period during which older people, their carers and professionals could make appropriate decisions about their future care needs.