The Associations Between Formal Home Care Service Levels and Health-Related Quality of Life of Older Adults Receiving this Care

Introduction: Home care (HC) services are increasingly central to support older adults with complex health needs, yet evidence remains limited on how variations in formal HC service provision are associated with health-related quality of life (HRQoL), particularly when measured using comprehensive assessment data. Objective: The objective of this research was to examine the associations between formal HC service levels and HRQoL for older adults receiving this care in Edmonton, Alberta. Methods: An observational, retrospective, longitudinal study was completed in Edmonton, Alberta which collected administrative data from Home Care clients who had completed the Resident Assessment Instrument-Home Care (RAI-HC) in sequential years. This data was mapped to the Health Utility Index 3 to report on HRQoL. Results: Data were obtained from 8743 clients aged 65 years or older who accepted HC between March 1, 2018 and February 29, 2020. Changes in HRQoL were assessed based on the profession of the service provider and the care type. Multivariable logistic regression was used to examine HC service levels by activity provision associated with improved/stable HRQoL outcomes. Results demonstrated a significant decrease in mean HRQoL for this population, outcomes over time, regardless of the profession, or type of care activity of the HC healthcare provider. Conclusion: Individuals who had fewer HC services at baseline were associated with better HRQoL and a higher likelihood of experiencing improved/stable HRQoL compared to those with more HC service time. Various factors were identified that correlated with a lower average HRQoL, including HC clients with a recent health diagnosis, being in an older age group, accessing respite care, and receiving higher levels of HC services. Now that these factors relating to diminished HRQoL have been identified, further research is needed to evaluate possible interventions targeting this issue.