No place like home?

Abstract

Backgrounds: The number of functionally dependent elderly needing care and medical treatment is rapidly growing. Worldwide, one is trying to develop an efficient policy to this change. Deinstitutionalisation and home-based care are important issues in these policies. Former studies have showed, that the elderly prefer receiving care at home rather than in a nursing home and that home-based care may save costs. The question we address in this paper is what the differences in quality of care are in these two settings. Goal: To answer the question whether and which are the differences in quality of care between home-based care and nursing home care, for dependent, non-demented elderly. Methods: Study of the literature from 1995 until now Results: 3 studies met our search criteria and were included. A controlled observational British study compared medical care quality in nursing homes to the medical care at home. The quality of medical care received in a nursing home was worse than the quality of medical care received at home. In a Dutch survey nurses in a nursing home showed more social behavior than nurses in home care. The communication of nurses in home care was more task-related. The recently published controlled-observational study from Missouri (USA) showed that participants of a specific community-based long term care program, had a favorable course of ADL, cognition, depression and incontinence, when compared to the matched individuals receiving care in a nursing home. Conclusion: There is insufficient information in the literature on the differences on quality of care between the nursing home and at-home care for functionally, dependent, non-demented elderly.