Day care vs home care: Effects on functional health outcomes among long-term care beneficiaries with dementia in Korea

Objectives: First, to compare changes in cognitive function, behavioral symptoms, and physical function for Korean Long-Term Care Insurance (LTCI) beneficiaries with dementia in day care (DC) and home care (HC) settings over 1 year. Second, to examine the association between LTCI service type and the aforementioned health outcomes. Methods: A retrospective matched cohort study was conducted using the national data set of the National Health Insurance Service in Korea. We identified 7822 beneficiaries with dementia who received either DC or HC services consistently for 1 year from 2008 to 2009. The propensity score matching method was used, yielding 416 participants in each group. Paired samples t-tests and logistic regression analyses were conducted. Results: Baseline differences between the two groups are present. According to multiple regression models, DC, when compared with HC, was related to less deterioration in cognitive and physical function but was associated with less improved behavioral symptoms 1 year after the LTCI enrollment. In the comparison between matched cohorts, DC, when compared with HC, was associated with less cognitive decline, less disability progression, and similar decrease in behavioral symptoms. Conclusions: Cognitive function and disability declined less in the DC group, compared with the HC group. Conversely, behavioral symptoms showed a similar decrease between the two groups after 1-year follow-up. Further research is necessary to examine key features of DC services that have helped delay functional deterioration and alleviate behavioral symptoms.