Dementia care costs and the patient's quality of life (QoL) in Taiwan: Home versus institutional care services

Kuo, Yu-Chun; Lan, Chung-Fu; Chen, Liang-Kung; Lan, Virginia M.

doi:10.1016/j.archger.2009.10.001

« Previous Next »Archives of Gerontology and Geriatrics
Volume 51, Issue 2 , Pages 159-163, September 2010

Dementia care costs and the patient's quality of life (QoL) in Taiwan: Home versus institutional care services

Yu-Chun Kuo
- Institute of Health and Welfare Policy, National Yang Ming University School of Medicine, No. 155, Section 2, Li-Nong Street, Taipei, 11221, Taiwan
- Institute of Health Policy and Management, National Taiwan University, No. 17, Hsu-Chow Rd., Taipei, 100, Taiwan
Chung-Fu Lan
- Institute of Health Policy and Management, National Taiwan University, No. 17, Hsu-Chow Rd., Taipei, 100, Taiwan
- Research Center of Health and Welfare Policy, National Yang Ming University School of Medicine, No. 155, Section 2, Li-Nong Street, Taipei, 11221, Taiwan
- Corresponding author at: Institute of Health Policy and Management, National Taiwan University, No. 17, Hsu-Chow Rd., Taipei, 100, Taiwan. Tel.: +886 2 2826 7051; fax: +886 2 2827 3673.
Liang-Kung Chen
- Division of Geriatric Medicine, Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan
- National Yang Ming University School of Medicine, No. 115, Li-Nong Street, Taipei, 11217, Taiwan
Virginia M. Lan
- School of Nursing, Eastern Michigan University, 341 Marshall Building, Ypsilanti, MI 48197, USA

Received 16 April 2009; received in revised form 22 September 2009; accepted 1 October 2009. published online 30 December 2009.

Abstract

Organizing optimal care for demented older people is a complex health care issue. Controversies of service models for demented patients should be balanced between cost of care, placement, and quality of life (QoL). The main purpose of this study was to explore the optimal model of dementia care in Taiwan by evaluating the care cost, patients’ QoL and healthcare settings. Overall, 140 pairs of demented patients and their primary informal caregivers were enrolled (89 community-living and 51 institute-living). Compared to institute-living subjects, community-living subjects were significantly better in cognition, physical function and QoL. The annual direct cost of institutional care was significantly higher than community care (464,193 New Taiwanese Dollar (NTD) vs. 144,047 (NTD), p<0.001), but indirect cost was significantly higher in home care (287,904 NTD vs. 35,665 NTD, p<0.001). The care cost of home care subjects with low physical dependence was significantly lower than institutional care subjects, but the care cost of home care subjects with high physical dependence was significantly higher than institutional care subjects. Physical dependence was the significant determinant of QoL for demented patients in this study. In conclusion, demented patients with low physical dependence may be cared in the communities with support and those who had high physical dependence may be cared in the institutes in terms of the balance of QoL and the care cost.