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

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.