Housing and Support Program (HASP): Final Evaluation Report

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62 Section 7 How do costs of providing care under HASP compare with alternative care options? A comprehensive economic evaluation of HASP would require considerable time and expertise (Lapsley et al., 2000) and, as such, is beyond the scope of this broader evaluation. In the absence of an in-depth economic evaluation, we have provided ‘estimates’ of the costs associated with both community and inpatient options. As such, a degree of caution is required when quoting or using the data from this section of the report. The costs associated with sourcing accommodation, locating support services and transitioning individuals into the community are diffi cult to quantify. Recurrent costs are much easier to identify since they are likely to be tied to each individual. An estimate of the recurrent costs associated with inpatient and community care are provided below. 7.1 Costs associated with community care There are three major contributors to the recurrent cost of community care — (i) costs associated with non-clinical support services (support agency, support workers), (ii) costs associated with the provision of mental health services (Case Manager, GP, etc) and (iii) inpatient care costs for those requiring admission to hospital. These different cost drivers are discussed below. (i) Disability support costs The average cost of providing disability support was estimated to be $47.50 per hour. This includes the cost of providing ‘in-home’ support services to clients and the administration costs associated with supervision and service coordination. Given that the average client was receiving 20 hours of support per week at followup, this would equate to a cost of $950 per week or $49,500 per annum. (ii) Case management costs The major costs in this category include those incurred in the provision of mental health services (e.g. case management and GP services). Given that the majority of clients receive a visit from their Case Manager every two weeks, or visit to a GP every two weeks, the estimated average cost is $4,500 pa (i.e. 30 visits per year at $150 per visit). Final Evaluation Report (iii) Inpatient care costs Despite the best efforts of all involved, a subgroup of clients will require admission to inpatient care. The average daily cost of an acute inpatient care in Queensland is estimated to be $670 per day (K Fjeldsoe, personal communication, Oct 2010). The average length of stay for those admitted to acute inpatient care in the 12 months post-HASP was 18.9 days. We have allocated one admission per client, per year, however, this is likely to be an overestimate given that the majority of clients did not require hospital admission (only 36.6% of clients required admission to acute inpatient care since joining HASP). Thus the cost of keeping a client in hospital post-HASP is approximately $12,663 (based on an average stay of 18.9 days at a cost of $670 per day). Table 7.1 Estimated costs of keeping client in HASP for 12 months Disability support costs Case management costs Acute inpatient care costs (per admission) TOTAL $66,663 $49,500 $ 4,500 $12,663 In summary, the approximate recurrent cost for the ‘average’ client in HASP (who has one admission to acute inpatient care in a given year) is $66,663 per year or $183 per day. Should the patient not require admission to acute care, the cost decreases to $54,000 or $148 per patient day.
7.2 Comparing HASP with inpatient/residential alternatives It should be noted that HASP clients could enter the program from a range of facilities, including acute inpatient units, community care units (CCUs) and extended treatment and rehabilitation units. It is reasonable to conclude that if clients could not access HASP, they would remain in one of these residential facilities. Thus it is useful to compare HASP costs with those associated with these ‘alternate’ facilities. The estimated costs of care in these facilities are provided in the table below. As a consequence of the additional costs associated with the provision of infrastructure, such as libraries and education departments at psychiatric hospitals (where two of the largest extended treatment units are located), the bed day cost at extended treatment and rehabilitation units is signifi cantly higher than at CCUs. Table 7.2 Cost of care — HASP versus alternative options. Service Type Annual/Daily Cost Acute Inpatient Unit Community Care Unit Extended Treatment & Rehabilitation Project 300 HASP (with one acute admission) HASP (no admission) 7.3 Cost of care pre and post-HASP Of the 80 clients in our sample, we have admission data (number of admissions and length of stay) for 70 clients at 12 months prior to entering HASP and 12 months post entry into HASP. The average time in inpatient care prior to HASP was 227 days and the average time post-HASP was 18.9 days. Most of the clients entered the program from an extended treatment and rehabilitation unit or from a community care unit. Given the cost estimates outlined in the table above, the average cost of care in an extended treatment unit for the 70 clients in the 12 months prior to HASP would be $147,550 per client (for a stay of 227 days), while the average cost post-HASP was $12,663 per client (for a stay of 18.9 days). $244,550 pa. ($670 per day) $140,525 pa. ($385 per day) $200,750 pa. ($650 per day) $ 60,626 pa. ($166 per day – in 2007) $66,663 pa. ($183 per day) $54,000 pa. ($148 per day) 7.4 Section summary It should be noted that there are considerable ‘upfront’ costs involved in sourcing accommodation for programs such as HASP. Most housing providers do not have a supply of surplus housing, therefore, housing options have to be purchased or constructed to meet the additional demand generated by these programs. These costs have not been considered in our estimate as they are diffi cult to estimate with any degree of accuracy. The recurrent costs for a client with an average of 20 hours of support per week ($66,663) are signifi cantly less expensive than keeping the same client in acute inpatient care or in a CCU. Indeed, our fi ndings suggest that it would be possible to keep two clients in HASP for the cost of keeping one client in a CCU, or four clients in HASP, for the cost of keeping one client in an acute inpatient unit. Housing and Support Program (HASP) 63
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Department of Psychiatry (UQ) and S
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Final Evaluation Report of the Quee
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• Community integration While eig
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List of contents Executive summary
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Section 1 Introduction Since the 19
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1.1.1 HASP — Management Structure
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1.2 Housing and supports - previous
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Table 1.2.2 Outcomes for clients mo
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activities, while others tried to c
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Page 35 and 36: Importance of the Supports Facilita
Page 37 and 38: Accountability There was a percepti
Page 39 and 40: Support workers highlighted issues
Page 41 and 42: 4.1.2 Client perceptions of support
Page 43 and 44: In general, Case Managers expressed
Page 45 and 46: 4.2.2 Client perceptions of the amo
Page 47 and 48: Support workers felt, as a result o
Page 49 and 50: 4.2.8 Amount of support required in
Page 51 and 52: 4.3.2 Living arrangements The major
Page 53 and 54: 4.3.7 Housing in HASP — compariso
Page 55 and 56: The majority of HASP clients (76%)
Page 57 and 58: 5.2 Satisfaction with key life doma
Page 59 and 60: 5.7 Depth of friendships We explore
Page 61 and 62: 5.11 Community involvement Clients
Page 63 and 64: 5.13 Section summary During our int
Page 65 and 66: etter functioning). However, while
Page 67 and 68: 6.7 Physical and mental health Link
Page 69: 6.10 Section summary The average ti
Page 73 and 74: of applications, increase Case Mana
Page 75 and 76: available when and where needed by
Page 77 and 78: 8.4 The ability of the program to m
Page 79 and 80: Section 9 Recommendations 1. More i
Page 81 and 82: Section 10 Reference list Anthony,
Page 83 and 84: Shepherd, G., Murray, A. & Muijen,
Page 85 and 86: Housing and Support Program (HASP)
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