SUBSTITUTING HOME CARE FOR HOSPITALIZATION - THE ROLE OF A QUICK RESPONSE SERVICE FOR THE ELDERLY

The purpose of the present study was to examine the role of a rapid ac cess home-based service as a means for the elderly to avoid admission to an acute-care hospital. The setting for the study included emergenc y departments in three acute care hospitals and a home care program in a mid-size Canadian city. Multiple sources of information were obtain ed to evaluate the service. Hospital emergency department records and home care records were reviewed. Patients who participated in the serv ice (n=96) and physicians and nurses (n=119) who had involvement with the service were surveyed appraising the service in terms of relevance , access, quality and coordination. Study results revealed that elderl y women with multiple health problems who lived alone were the most fr equent users of the service. The majority of the patients admitted to the service presented with problems of a functional nature that were t he result of a fall or mobility problems. The results indicated that t he service did avert hospital admissions and facilitated a process by which patients could avoid the intermediate step of hospitalization be fore placed in a higher level of care or returning to previous levels of functioning. Economic analysis indicated that the value of the serv ice stemmed from the benefits to patients and caregivers rather than f rom cost savings offered to acute care hospitals.