Inter-provincial variation in older home care clients and their pathways: a population-based retrospective cohort study in Canada

Lori Mitchell; Jeffrey Poss; Martha MacDonald; Rosanne Burke; Janice M Keefe

doi:10.1186/s12877-023-04097-5

Inter-provincial variation in older home care clients and their pathways: a population-based retrospective cohort study in Canada

BMC Geriatr. 2023 Jun 26;23(1):389. doi: 10.1186/s12877-023-04097-5.

Authors

Lori Mitchell¹, Jeffrey Poss², Martha MacDonald³, Rosanne Burke⁴, Janice M Keefe⁵

Affiliations

¹ Shared Health Manitoba, Winnipeg, MB, Canada. lmitchell3@sharedhealthmb.ca.
² School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada.
³ Saint Mary's University, Halifax, NS, Canada.
⁴ Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada.
⁵ Department of Family Studies and Gerontology and Director, Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada.

Abstract

Background: In Canada, publicly-funded home care programs enable older adults to remain and be cared for in their home for as long as possible but they often differ in types of services offered, and the way services are delivered. This paper examines whether these differing approaches to care shape the pathway that home care clients will take. Older adult client pathways refer to trajectories within, and out of, the home care system (e.g., improvement, long term care (LTC) placement, death).

Methods: A retrospective analysis of home care assessment data (RAI-HC was linked with health administrative data, long-term care admissions and vital statistics in Nova Scotia Health (NSH) and Winnipeg Regional Health Authority (WRHA). The study cohort consists of clients age 60 + years, admitted to home care between January 1, 2011 to December 31, 2013 and up to four years from baseline. Differences in home care service use, client characteristics and their pathways were tested across the two jurisdictions overall, and among the four discharge streams within jurisdictions using t-tests and chi-square tests of significance.

Results: NS and WHRA clients were similar in age, sex, and marital status. NS clients had higher levels of need (ADL, cognitive impairment, CHESS) at base line and were more likely discharged to LTC (43% compared to 38% in WRHA). Caregiver distress was a factor correlated with being discharged to LTC. While a third remained as home care clients after 4 years; more than half were no longer in the community - either discharged to LTC placement or death. Such discharges occurred on average at around two years, a relatively short time period.

Conclusions: By following older clients over 4 years, we provide enhanced evidence of client pathways, the characteristics that influence these paths, as well as the length of time to the outcomes. This evidence is central to identification of clients at risk in the community and aids in planning for future home care servicing needs that will allow more older adults to remain living in the community.

Keywords: Canadian Home Care; Client outcomes; Client pathways; interRAI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Canada / epidemiology
Caregivers / psychology
Home Care Services*
Humans
Long-Term Care
Retrospective Studies

Grants and funding

FRN155950/CIHR/Canada