articleHome and community care services : a major opportunity for preventive health care

Background: In Australia, the Home and Community Care (HACC) program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. Methods: We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. Results: 4,978 (4.8%) participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis. Conclusions: HACC clients have high rates of modifiable lifestyle risk factors and health conditions that are amenable to primary and secondary prevention, presenting the potential for implementing preventive health care programs in the HACC service setting. Background The Australian Home and Community Care (HACC) program provides services in the community to frail elderly and people with disabilities living at home and their carers [1]. It aims to support their independence, to enhance their quality of life and to prevent their inappropriate admission to long term residential care [1]. Services vary with the needs of the client and include nursing and allied health care, personal care, meals, household assistance, transport, day centres and respite care [1,2]. Lifestyle modification is not a major current focus of HACC service provision, but policymakers are beginning to recognise the health promotion role that the program can play. New service models emphasise the role of the HACC program in supporting gains in health and wellbeing [3]. HACC receives AUD1.8 billion annually from the Commonwealth and State governments supplemented by client fees that amount to 5% of revenue [4]. Around 3,300 agencies deliver HACC services to approximately 830,000 people annually [1]. HACC providers include local government, community and charitable groups, and private for profit organisations. As the population ages, the demands for HACC services are likely to increase, along with demands for other health care services. Recent national reviews of the Aus* Correspondence: l.jorm@uws.edu. au 1 School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith South DC NSW 1797, Australia Full list of author information is available at the end of the article BioMed Central © 2010 Jorm et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Jorm et al. BMC Geriatrics 2010, 10:26 http://www.biomedcentral. com/1471-2318/10/26 Page 2 of 9 tralian health system [5-7] all highlight the need for better integration of pathways of care, and for greater emphasis on prevention of chronic conditions. Given the pivotal role of HACC services in caring for older people, they may provide an ideal opportunity for targeting preventive services to those with high prevalence of risk factors. However, little is known about the individuals who use these services, and there is scant evidence on which to assess the potential of community care as a setting for the delivery of preventive health interventions. HACC program data collections only report descriptive demographic data and indicators of service need [1,8]. The Australian national Survey of Disability, Ageing and Carers does not report specifically on HACC clients [9]. Two Australian studies--both more than a decade old, and both restricted to limited geographic areas--found that service use was independently related to older age, activity limitations and indicators of poor health (including self-rated health and health service use) [10,11]. A more recent study from Western Australia used HACC program data coupled with client assessments to show that the strongest predictors of HACC resource use were dependency in activities of daily living (ADL) or instrumental activities of daily living (IADL) and needs for clinical care [12]. These Australian findings were consistent with international studies, which have reported that impairments to ADL have the strongest association with use of community care; other important factors include being older, female, non-white, living alone, having fewer children, having multiple chronic conditions, and geographic variations in the availability of services [13,14]. The purpose of our study was to describe the healthrelated factors that are associated with use of HACC services in Australia in a large, contemporary, populationbased sample. We used baseline questionnaire data from Australia's largest cohort study--the 45 and Up Study-linked with administrative data relating to HACC services.