Use of home care services by older Veterans and dependants in Melbourne, Australia, 2007-2016

Introduction: Military life may have a lasting effect on Veterans and their dependants, resulting in a different aging experience than among the general population. This study investigated the home care utilization of older community-living individuals supported by the Australian Department of Veterans' Affairs (DVA). Methods: This was a retrospective cohort study covering 10 years of data (Jan. 1, 2007-Dec. 31, 2016) on episodes of care provided by a home care organization. Veterans and dependants were compared with age- and gender-matched non-DVA-supported clients. Descriptive statistics and generalized linear mixed-effects modelling were used to characterize home care requirements. Results: Of 26,093 episodes, 45.3% involved Veterans (91.7% male) and 54.7% involved dependants (99.6% female). The median hours of care per episode for Veterans and dependants were 60% and 62% more, respectively, than for non-DVA-supported individuals. Veterans and dependants were 3.3 and 3.8 times more likely, respectively, to utilize assistance with personal care. After adjusting for confounding, Veterans and dependants were associated with 16% and 14% more hours of home care per episode, respectively. Cognitive dysfunction and complex care requirements increased the hours of care by, on average, 17% and 52%, respectively. Compared with episodes involving non-DVA-supported clients, episodes with Veterans and dependants were 35% more likely to result in a transfer to hospital. Discussion: Veterans and dependants used more home care assistance to live in the community than their non-DVA-supported compatriots. Appropriate and adequate health and welfare services need to be developed for this unique group to support well-being into later life. LAY SUMMARY Military service has an impact on health and well-being across the life course. However, there is little research on older Veterans and dependants who use home care to enable them to remain living in the community. The authors analysed data from a Melbourne, Australia, home care organization's electronic care records to explore the differences between clients supported by the Department of Veterans' Affairs and clients in the general home nursing population. Results showed the greater needs of and complexity of care utilized by Veterans and dependants. Funding structures and support services need to account for these needs in older age.