Gatekeepers to home and community care services: the link between client characteristics and source of referral.

Objectives: To identify characteristics associated with the likelihood of a client receiving a referral to the Home and Community Care (HACC) program from various sources.

Methods: Data were collected from 73809 home care clients during 2007-08. Binary logistic and multinomial logistic regression were used to investigate the likelihood of a client being referred by health workers v. non-health workers.

Results: Females and clients cared for by their parents were less likely to receive referrals from health workers than non-health workers after confounding variables were controlled for. While poorer functional ability of clients increased the probability of receiving a referral from a health worker, the opposite was true for those with behavioural problems. Over 43% of the sample either self-referred or was referred by family or friends.

Conclusions: Eligible individuals may miss out on services unless they or their family take the initiative to refer. There is a need for improved methods and incentives to support and encourage health workers to refer eligible individuals to the program. What is known about the topic? The absence or inappropriate referral to a suitable home care program can place pressure on formalised institutions and increase burdens on family members and the community. Factors largely unrelated to healthcare needs carry significant weight in determining hospital discharge decisions and home care referrals by practitioners. What does this paper add? The effectiveness of the HACC program is dependent on the referrer who acts to inform and facilitate individuals to the program. The purpose of this study is to identify the characteristics associated with the likelihood of individuals receiving a referral to the HACC program from various sources. What are the implications for practitioners? This study will assist policy makers and practitioners in developing effective strategies that transition individuals to suitable home care services in a timely manner. An effective referral process would provide opportunities for implementing preventative strategies that reduce disability rates among individuals and the burden of care for the community. For instance, individuals with unmet needs may be at higher risk from injury at home through inadequate monitoring of nutrient and medication intake and inappropriate home surroundings. Improving knowledge about care options and providing appropriate incentives that encourage health workers to refer individuals would be an effective start in improving the health outcomes of an ageing population.