Cutting house cleaning help to elderly leads to higher health costs down the line.

Back in the mid-1990s, when provincial health budgets came under increasing pressure, some regions cut "frills" such as house cleaning to the frail elderly in order to save the health system money.

But a new BC study, which followed what happened to a large group of clients who were cut from service, shows that the supposed cost-saving move was penny-wise and pound-foolish. Those clients no longer receiving low-level help cost the system significantly more two to three years later than other clients whose services were maintained. Not only that, more of them died and more were admitted to long term care institutions.

"While the original logic of cutting people who only needed house cleaning seemed reasonable at the time, our results show that this logic is false. These simple, cheap services appear to help maintain the elderly person's functioning and prevent his or her deterioration," said study author, Marcus Hollander, PhD. "We found that a significant proportion of people seemed to have a health care crisis a year or two after their services were cut that ultimately cost the system more."

Dr. Hollander, president of Hollander Analytical Services Ltd., a Victoria-based health research firm, released the results of the study during a presentation at the Canadian Health Economics Research Association (CHERA) meeting in Toronto Friday.

The unique study, funded by Health Canada, made use of a natural experiment that occurred in British Columbia beginning in late 1994 when the government instituted a policy to cut service to clients with minimal care needs. Specifically, most of the services that were cut consisted of house cleaning help. Not all health units in the province, however, put the policy in place at the same time and in the same manner. Dr. Hollander and his research team, therefore, were able to follow a large group of clients in two health units that made severe cuts to similar clients in two other health units that did not make cuts. The research study examined all the health care costs for both groups one year prior to the cuts and then for three years after the cuts. Using a unique database at the University of British Columbia, the researchers analyzed the costs and utilization of hospital services, physicians' services, pharmaceuticals, long term care and chronic care facilities, home nursing, community rehabilitation, home support and adult day care services.

The study found that while there was no difference between the two groups in the first year after the cuts, during the second and third years costs were significantly higher for the people who had been cut compared to the group whose services were maintained. In fact, by the third year, the annual per person average costs of all health services had risen to $11,903 for the group that had been cut compared to $7,808 for people who had not been cut from care.

"By the end of the third year, the difference in total average cost to the health system was about $4,000 more per person, so clearly this 'cost-saving' measure was not cost-saving at all," notes Dr. Hollander.

In addition, death rates and rates of institutionalization were higher in the group cut from service. By the end of the third year, 21.6 per cent of the group cut from care had died compared to just 14.5 per cent of those in health units without cuts. An equivalent of 17 per cent of the group with cuts had been admitted to long term care facilities compared to just 7 per cent in the group without cuts.

"The cuts have an emotional cost as well as a fiscal cost," Hollander said. In a companion qualitative study by Georgia Livadiotakis, a gerontology masters student at Simon Fraser University, a group of 137 seniors cut from service in 1999 were interviewed a year and a half later and asked "How are you coping since your home support was eliminated?" The results found that more than one third, or 35 per cent, felt lonely, abandoned and betrayed.

"Ignoring the preventive aspects of home care may not only lead to increased costs in the overall health system, but may also lead to increased suffering and distress for a significant portion of people who are cut from care," Dr. Hollander said.

More research needs to be conducted on why such a simple service as house cleaning helps prevent deterioration. "We know these people are very frail - perhaps without help they fall trying to do too much or simply get more run down because they don't have assistance. Or perhaps it is more related to the fact that someone is checking up on them, they feel more cared for and that without it they have little social contact. We don't really know why house cleaning has such a large impact."

Dr. Marcus Hollander presented the findings of the study "Evaluation of the Maintenance and Preventive Function of Home Care" Friday May 25th at the annual Canadian Health Economics Research Association conference held in Toronto. To arrange an interview with Dr. Hollander or to obtain a copy of the report, please call Hollander Analytical Services Ltd. in Victoria, (250) 384-2776.

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