Dementia poses a significant cost burden to health and social care systems. Providing the most cost-effective mix of services is, therefore, becoming a priority for policy-makers in many countries. Evidence suggests that shifting the balance of resource allocation towards more personalised community-based supports can reduce the risk of institutionalisation for some older people on the boundary of care. The objective of this study is to estimate resource utilisation, cost of care and outcomes

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... r people with dementia on the boundary of community and residential care in Ireland, within an innovative, personalised, community-based programme of care for people with dementia. Methods: A balance of care approach was used to examine how investment in personalised community care can impact on costs, outcomes and admission to long-stay care facilities for people with dementia. The study examines resource use, costs and outcomes for people with dementia, whose needs can potentially be met in alternative settings, over a three year period. Formal and informal resource use is assessed, as well as housing, personal consumption and residential care costs. Results: 181 people with dementia on the boundary of care were supported to remain living in the community, receiving a total of 34,635 personalised support hours at a cost of €953,533. The total cost of formal community care was €4,804,563, while the cost of informal care was €8,586,096. In contributing to potentially keeping people living at home for longer, the estimated public expenditure saving associated with the programme was €3,169,561. Conclusions: Personalised supports are likely to support family carers to continue caring for longer, thus postponing expensive admission to long-stay care facilities. The study has shown that it is possible to increase the availability of personalised supports for people with dementia to augment existing formal care provision and still not exceed residential care costs.