PATTERNS AND COSTS OF POST-ACUTE CARE - A LONGITUDINAL-STUDY OF PEOPLE AGED 60 AND OVER IN DUBBO

Declining length of stay of older people in hospital has caused concer n about shifting of costs from acute to community care services. Becau se the two types of care are funded through different programs and fro m different jurisdictions, the coordination of acute and post-acute ca re has become the major issue. There is, however, little information a vailable on patterns of use and costs of post-acute care either in Aus tralia or elsewhere. In an existing longitudinal community study of ol der people in Dubbo, New South Wales, data on use of services by peopl e aged 60 years and over for 12 months of hospitalisations was collect ed by linkage to the records of Home and Community Care providers. Onl y a quarter of older people received any type of Home and Community Ca re service in the 12 weeks after discharge and two-thirds of these rec eived only one type of service. While less than 5 per cent received a service from an occupational therapist, physiotherapist or speech ther apist, 78 per cent visited a general practitioner after discharge. The average cost of all Home and Community Care services received after h ospital discharge was around $12.50 per week per person discharged. Th e predictors of higher costs of service use were: living alone, and th e interactions of high levels of disability with owning a house. Resul ts on service coordination, the identification of postacute services, cost consequences of program funding, assessment and discharge plannin g are related to debates emerging from the Commonwealth Heads of Gover nment.