A cost and outcomes analysis of alternative models of care for young children with severe disabilities in Ireland

Young children born with severe disabilities in Ireland may receive either continuous hospital inpatient care or homecare services in their family environment. In practice, a charitable body – the Jack and Jill Foundation (JJF) – is the predominant provider of home-care. This non-statutory homecare service is often supplemented by statutory homecare services, through Primary Community and Continuing Care teams. The purposes of this exploratory study are twofold: firstly, we compare costs (both direct and indirect) associated with hospital inpatient care and JJF homecare; secondly, we compare levels of family satisfaction for recipients of continuous hospital inpatient care, JJF homecare and statutory homecare services. Direct costs appear to be substantially greater for the hospital inpatient model than for JJF homecare, from the perspective of both the health service (€156,282 versus €16,267) and of families (€22,261 versus €2,620). Indirect productivity costs are more closely matched at €27,728 for the hospital inpatient model and €22,941 for JJF homecare. Satisfaction ratings were greatest for JJF, with a mean rating of 4.89 out of 5, compared to 3.28 for inpatient hospital care, and just 2.86 for statutory homecare services. Findings support previous research that the homecare model is likely to be cost-effective, with lower costs falling on both providers and on families. In addition, families expressed a clear preference for care to be provided at home.