Using more end-of-life homecare services is associated with using fewer acute care services: A population-based cohort study

Background: Healthcare systems are investing in end-of-life homecare to reduce acute care use. However, little evidence exists on the timing and amount of homecare services necessary to reduce acute care utilization. Objectives: To investigate whether admission time to homecare and the amount of services, as measured by average nursing and personal support and homemaking (PSH) hours/week (h/wk), are associated with using acute care services at end-of-life. Research Design: Retrospective observational cohort study. Subjects: Decedents admitted to end-of-life homecare in Ontario, Canada. Measures: The odds ratios (OR) of having a hospitalization or emergency room visit in the 2 weeks before death and dying in a hospital. Results: The cohort (n = 9018) used an average of 3.11 (SD = 4.87) nursing h/wk, 3.18 (SD = 6.89) PSH h/wk, and 18% were admitted to homecare for <1 month. As admission time to death and homecare services increased, the adjusted OR of an outcome decreased in a dose response manner. Patients admitted earlier than 6 months before death had a 35% (95% CI: 25%-44%) lower OR of hospitalization than those admitted 3 to 4 weeks before death; patients using more than 7 nursing h/wk and more than 7 PSH h/wk had a 50% (95% CI: 37%-60%) and 35% (95% CI: 21%-47%) lower OR of a hospitalization, respectively, than patients using 1 h/wk, controlling for other covariates. Other outcomes had similar results. Conclusion: These results suggest that early homecare admission and increased homecare services will help alleviate the demand for hospital resources at end-of-life.