Table 2.

Summary of sources that discussed out-of-pocket expenses as outcomes in evaluating policies, programs, and services related to aging in place for frail older people

Author Country	Intervention (program/service/policy)	Brief description	Method of evaluation	Findings related to out-of-pocket expenses
Béland et al.60 Canada	Community-based multidisciplinary teams	Provision of community-based multidisciplinary integrated care	RCT	No difference was found for out-of-pocket expenditures between control and intervention groups
Dosman and Keating61 Canada	Program	Provision of high-level care for individuals in a home-like environment	Focus groups	Costs incurred for caregivers included insurance payments, safety equipment, and maintenance/repair expenses
Flood et al.65 UK	Program	Community assessments provided by social workers and occupational therapists	Cost comparison	Costs for participants assessed by social workers were higher; however, the difference was significant only to caregivers
Leutz et al.47 US	Social HMO program	Provision of community-based care services	Qualitative interviews	Some people were found to have expenses beyond program coverage (eg, home care, yard work) Described additional out-of-pocket payments associated with the program that varied according to need
Meng et al.48 US	Voucher program	Vouchers used to reimburse personal assistance expenditures	Quantitative survey data	Intervention group had higher expenditures, and those with higher functional impairment had higher service usage
Moon et al.49 US	Policy	Description of financial implications of older adults’ complex health needs	Policy analysis	Older people with complex needs have higher out-of-pocket expenses Describes proposed complex care option for Medicare
Parker and Hill82 UK	Program	Home-based and day hospital rehabilitation	RCT	Cost analysis found no significant difference between total costs of intervention and control groups
Schwab et al.54 US	Social HMO program	Provision of community-based care services	Gathering actual costs	Average annual estimated costs of services were found to be US$4900 out-of-pocket No comparison with group who received social HMO
Stuart and Hansen72 Denmark	Policy	Description of care services for older people with frailty in Denmark	Policy analysis	Description of how public services and family caregivers cooperate to provide care Note that some out-of-pocket expenses occurred; however, overall sources provided adequate support

HMO, health maintenance organization; RCT, randomized controlled trial.