Hospital stays for older people are shorter in areas with better supply of home care and residential care services

September 18, 2019
Seán Lyons, Samantha Smith, Brendan Walsh and Maev-Anne Wren, some of the authors of "An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital". They are pictured at a healthcare conference held by the ESRI on 24 September 2019. 

Seán Lyons, Samantha Smith, Brendan Walsh and Maev-Anne Wren, some of the authors of "An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital". They are pictured at a healthcare conference held by the ESRI on 24 September 2019. 

There is a clear link between older patients’ hospital stay duration and the supply of home care and long-term residential care in their area. This is according to new research titled An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital published today by the Economic and Social Research Institute as part of a Health Research Board funded project. Improving home care and residential care can in part help reduce hospital stays for some patients.

Project overview

This is the second report from a project that aims to provide evidence on the supply of care in the community and to inform policies, such as Sláintecare, that aim to move care from acute hospitals to the community. This report analysed how care supply within hospital (hospital beds) and outside of the hospital affects hospital stay duration. The analysis of older peoples’ care services linked data on all emergency (non-elective) public hospital admissions from 2010 to 2015 with data on local supply of home care and residential care.

The research examined whether patients aged over 65 in areas with better home care and residential care supply are discharged more quickly from hospital, holding constant patient characteristics such as age and diagnosis.

Key findings

Older patients from areas with more home care and residential care (e.g. nursing homes) had shorter hospital stays. The research showed that:

  • For home care, a 10 per cent increase in supply per capita would equate to approximately 14,700 fewer inpatient bed days per annum, the equivalent of 40 inpatient beds daily;
  • For residential care, a 10 per cent increase in supply per capita would equate to approximately 19,000 fewer inpatient bed days per annum, the equivalent of 53 inpatient beds daily;
  • In areas where increases in home care supply were largest, the scale of the effect found was much greater, especially for patients with very long stays;
  • For both services, increased supply was associated with much larger reductions in hospital stays for patients most likely to benefit from post-discharge care: older patients, and patients with stroke, hip fracture or Alzheimer’s/dementia;
  • The report also found when inpatient bed supply was cut during the great recession, hospital length of stay reduced for patients of all ages. While data limitations prevented examination of whether these cuts affected patients’ outcomes, this result does highlight the importance of both in-hospital and outside of hospital supply on patients’ length of stay.

Policy implications

Better home care and long-term residential care supply can help reduce older patients’ length of stay, especially patients most in need of these services. Increasing home care and residential care supply is essential to meet the needs of a growing and ageing population. Increasing the supply of these services will also help reduce some pressures on hospitals. However, increased hospital capacity will still be required in light of long elective waiting lists, and the highest inpatient bed occupancy rate in the OECD.

One of the report authors, Brendan Walsh, ESRI, stated: “Increasing the supply of home care and nursing home beds can help reduce pressure on hospitals, but it is not a panacea. Increasing supply of these services as the population grows and ages is imperative. But so too is the continued investment in hospital capacity.”

Speaking about the report, Darrin Morrissey, Chief Executive of the Health Research Board says, "This report reinforces the importance of having research to inform decision making around health in order to ensure people get the right care, in the right place at the right time".