Centre for Economic and Social Research on Dementia, Institute for Lifecourse and Society, National University of Ireland, Galway, Ireland.
School of Business and Economics, National University of Ireland, Galway, Ireland.
Dementia (London). 2021 Jan;20(1):47-65. doi: 10.1177/1471301219863580. Epub 2019 Jul 26.
This study analysed the cost of intensive home care packages for people with dementia living on the boundary of home care and residential care facilities in Ireland. The cost of community-based services and supports, including informal care and private out-of-pocket expenditure, was compared to the cost of public and private residential care.
The study recruited 42 people with dementia and/or their caregivers, who were living on the boundary of home care and residential care, to an in-depth study on the cost of care. The Resource Utilization in Dementia scale was used to collect data on the utilization of standard formal care and informal care by people with dementia in receipt of an intensive home care package. Information on private out-of-pocket expenditure on care was also collected. Unit costs were assigned and community-based care was compared with public and private residential care alternatives.
The average weekly cost of home care, including the intensive home care package, standard formal community care provision, medications, consumption and housing, was estimated at €1127. This is lower than the average weekly cost of public long-stay care facilities (€1526) and around the same as for private nursing home fees in the Dublin region (€1149). When the opportunity cost valuation of informal care is included, the cost of home care is higher than all types of residential care. Adding private care expenditure further inflates the cost of home care.
Keeping highly dependent people with dementia living at home is not cheap and raises questions about optimal resource allocation on the boundary of home care and residential care. Even with significant public spending on intensive home care packages, family care costs remain high. So too does private out-of-pocket expenditure on care for some people with dementia.
本研究分析了爱尔兰居家护理和养老院之间的痴呆症患者强化家庭护理套餐的成本。比较了社区服务和支持的成本，包括非正式护理和私人自掏腰包的支出，以及公共和私人养老院的成本。
本研究招募了 42 名患有痴呆症和/或其照顾者的人，他们处于居家护理和养老院之间的边界，对护理成本进行深入研究。使用资源利用在痴呆症量表收集接受强化家庭护理套餐的痴呆症患者标准正式护理和非正式护理的利用数据。还收集了私人自掏腰包护理支出的信息。分配单位成本，并将基于社区的护理与公共和私人养老院替代方案进行比较。
包括强化家庭护理套餐、标准正式社区护理提供、药物、消耗品和住房在内的家庭护理每周平均费用估计为 1127 欧元。这低于公共长期护理设施的每周平均费用（1526 欧元），与都柏林地区私人养老院的费用大致相同（1149 欧元）。当包括非正式护理的机会成本估值时，家庭护理的成本高于所有类型的养老院护理。增加私人护理支出进一步增加了家庭护理的成本。
让高度依赖的痴呆症患者留在家里并不便宜，这引发了关于居家护理和养老院之间最佳资源分配的问题。即使对强化家庭护理套餐进行了大量公共支出，家庭护理成本仍然很高。对于一些痴呆症患者来说，私人自掏腰包的护理支出也是如此。
