The effect of frailty and cognitive impairment levels on formal and informal care time for older adults in the community

Abstract

OBJECTIVE: Community care requires varying resources input that is mainly affected by a person’s frailty level. Less well understood is the variation in the respective contribution of formal and informal care, and whether it is affected by frailty and cognitive levels. This study investigated formal and informal care time in a community case-mix sample. DATA: Formal and informal care time (in hours) was collected over a 4-week duration. Information about frailty and cognitive level was collected using the interRAI-HC 9.1 instrument, and categorized by resources utilization groups (RUGs) and Cognitive Performance Scale (CPS). METHODS: Cross-sectional staff-time measurement (STM) study with participants recruited from day care and home care services units in Hong Kong according to the territory’s current service user ratio in each service. RESULTS: A total of 298 community care service users participated. The informal-to-total care time ranged from 0.16 to 0.50. Participants in the RUG groups of ‘Extensive and Special Care’ and ‘Clinically Complex with high ADL Need’ had the highest informal care time ratio. While total care time substantially increased from cognitively intact to very severe impairment on CPS, informal care time ratio remained high throughout, at over 0.8 across impairment levels. POLICY IMPLICATIONS: Policies aiming at supporting ageing-in-place and rational interfacing between community and residential care should take into account the disproportionate contribution of informal care as levels of frailty/resources utilization increase, in particular for people with cognitive impairment.