Comparison of mortality and hospitalisation rates amongst older adults residing in professional foster families versus nursing homes: two parallel observational studies

BACKGROUND: There is an urgent need to offer alternatives to nursing homes. Amongst them, professional foster families with paramedical supervision have never been studied. OBJECTIVES: This study aimed to compare the 1-year mortality, hospitalisation and emergency department visit rates between older adults in foster families and those in nursing homes. DESIGN: Two parallel cohort studies conducted in foster families (n = 107) and nursing homes (n = 332). METHODS: Adults aged ≥60 years were followed for 1 year, with assessments at baseline, 6 and 12 months. Primary outcomes included 12-month mortality, hospitalisations and emergency visits without hospitalisation. Secondary outcomes included cognitive decline [Mini-Mental State Examination (MMSE)], functional dependence [activities of daily living (ADL)], and health-related quality of life (EQ-5D). RESULTS: Baseline characteristics, including comorbidities and cognitive impairment (MMSE ≤18), were similar across groups. However, full functional dependence (ADL = 0) was more frequent amongst foster family residents (35.4% versus 18.2%; P = .01). After 12 months, mortality was 24.2% in foster families and 21.9% in nursing homes [adjusted odd ratio (OR) = 0.83; 95% CI, 0.42-1.66; P = 0.599]. Hospitalisation occurred in 6.1% versus 8.6% (adjusted OR = 0.74; 95% CI, 0.28-2.00; P = .547), and emergency visits in 9.1% versus 9.3% (adjusted OR = 0.94; 95% CI, 0.37-2.37, P = 0.889). Cognitive decline was similar. Foster family residents showed greater functional decline (β = -0.69; P < .001) but better quality of life maintenance (β = 0.08; P = .004). CONCLUSION: Professional foster families are a viable alternative to nursing homes, achieving comparable health outcomes at 1 year and at lower cost. Their development should consider cultural, clinical, and socioeconomic contexts.