• home care;
  • case manager;
  • nursing home admission

OBJECTIVES: To explore the relationship between a case management approach and the risk of institutionalization in a large European population of frail, old people in home care.

DESIGN: Retrospective cohort study.

SETTING: Eleven European countries.

PARTICIPANTS: Three thousand two hundred ninety-two older adults receiving home care (mean age 82.3±7.3).

MEASUREMENTS: Data on nursing home admission were collected every 6 months for 1 year.

RESULTS: One thousand one hundred eighty-four (36%) persons received a home care program based on case management, and 2,108 (64%) received a traditional care approach (no case manager). During the 1-year follow-up, 81 of 1,184 clients (6.8%) in the case management group and 274 of 2,108 (13%) in the traditional care group were admitted to a nursing home (P<.001). After adjusting for potential confounders, the risk of nursing home admission was significantly lower for participants in the case management group than for those in a traditional care model (adjusted odds ratio=0.56, 95% confidence interval=0.43–0.63).

CONCLUSION: Home care services based on a case management approach reduce risk of institutionalization and likely lower costs.