Cost of Community Care for Dementia and Cognitive Impairment in Hong Kong Chinese: Social and Informal Care Time Analysis

Abstract

Background: Social care and informal care constitutes the largest amount of economic cost in the care of dementia. Using data from a comprehensive health and functioning assessment tool for community-dwelling elders in Hong Kong and staff time measurement, this study aims to investigate the cost of care for dementia in terms of care time, to inform rational social care resources allocation to support persons with dementia and their caregivers in the community. Method: The sample consists of 298 frail elders using community care service users aged 60 years or above in Hong Kong. Participants were interviewed using the interRAI Home Care 9.1 assessment form between May and August 2014. Data on the types and volume (in time) of formal social care and informal care used over 4 weeks were collected. Cognitive impairment was divided into seven levels according to the interRAI Cognitive Performance Scale. Availability of a dementia diagnosis was also recorded. Results: The sample had a mean age of 81 years. Total daily care time and the corresponding annual care cost increases from 2.5 ± 2.8 hours and HK$51,728 (US$6,632) among cognitively intact participants to 8.9 ± 3.1 hours and HK$187,145 (US$23,993) among those who are very severely impaired. One-third (35%) have a diagnosis of dementia, 14% have moderate cognitive impairment without a dementia diagnosis, and the remaining half (51%) having mild to no cognitive impairment. The three diagnostic groups used on average 5.8, 6.5, and 2.4 hours of social and informal care per day, respectively. Participants diagnosed with dementia used more formal care provided by supportive care workers than the other two groups ([F(5,288)=22.5, p=0.00; adjusted R2=0.27). The use of professional formal care services was comparable among the three groups. Discussion: Care time and costs increased more than three times with increasing levels of cognitive impairment. Frail elders with moderate cognitive impairment with or without a dementia diagnosis used comparable informal care, which is significantly higher than frail elders with mild or no cognitive impairment. Formal non-professional care may be more available to those with a diagnosis. Resources allocation to support community care of frail elders should take into account the substantial informal care cost for cognitive impairment regardless of dementia diagnosis.