Abstract
BackgroundHome care is becoming an increasingly vital sector in the health care system yet very little is known about the characteristics of home care clients and the quality of care provided in Canada. We describe these clients and evaluate home care quality indicator rates in two regions.MethodsA cross-sectional analysis of assessments completed for older (age 65+) home care clients in both Ontario (n = 102,504) and the Winnipeg Regional Health Authority (n = 9,250) of Manitoba, using the Resident Assessment Instrument for Home Care (RAI-HC). This assessment has been mandated for use in these two regions and the indicators are generated directly from items within the assessment. The indicators are expressed as rates of negative outcomes (e.g., falls, dehydration). Client-level risk adjustment of the indicator rates was used to enable fair comparisons between the regions.ResultsClients had a mean age of 83.2 years, the majority were female (68.6%) and the regions were very similar on these demographic characteristics. Nearly all clients (92.4%) required full assistance with instrumental activities of daily living (IADLs), approximately 35% had activities of daily living (ADL) impairments, and nearly 50% had some degree of cognitive impairment, which was higher among clients in Ontario (48.8% vs. 37.0%). The highest quality indicator rates were related to clients who had ADL/rehabilitation potential but were not receiving therapy (range: 66.8%-91.6%) and the rate of cognitive decline (65.4%-76.3%). Ontario clients had higher unadjusted rates across 18 of the 22 indicators and the unadjusted differences between the two provinces ranged from 0.6% to 28.4%. For 13 of the 19 indicators that have risk adjustment, after applying the risk adjustment methodology, the difference between the adjusted rates in the two regions was reduced.ConclusionsHome care clients in these two regions are experiencing a significant level of functional and cognitive impairment, health instability and daily pain. The quality indicators provide some important insight into variations between the two regions and can serve as an important decision-support tool for flagging potential quality issues and isolating areas for improvement.
Highlights
Home care is becoming an increasingly vital sector in the health care system yet very little is known about the characteristics of home care clients and the quality of care provided in Canada
For the current study, data from Ontario and the Winnipeg Regional Health Authority (WRHA) were chosen based on several criteria including the fact that they are two of the four provinces who have submitted Resident Assessment Instrument for Home Care (RAI-HC) data to a national data warehouse, they have submitted a large number of assessments and they have the longest history of RAI-HC implementation in Canada
35% of the sample experienced Activities of Daily Living (ADLs) impairment, and nearly 50% of the clients had some degree of cognitive impairment
Summary
Home care is becoming an increasingly vital sector in the health care system yet very little is known about the characteristics of home care clients and the quality of care provided in Canada. We describe these clients and evaluate home care quality indicator rates in two regions. In several US states (e.g., Michigan, New Jersey, Massachusetts, North Carolina) and in multiple regions in Canada, including Ontario and in the Winnipeg area of Manitoba (Winnipeg Regional Health Authority or WRHA), the Resident Assessment Instrument for Home Care (RAI-HC) is being used for assessing home care clients in a standardized fashion. The CAPs are generated with computer software and there is written documentation for each CAP that provides the assessor with guidance in terms of further assessment and development of a care plan (see Table 1 for detailed descriptions of the CAPs)
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