Use Of Home Care Services Research Articles

Use of Home Care Services Reduces Caregiving-Related Strain in Long-Distance Caregivers

Long-distance caregivers (LDCs) comprise a growing yet relatively understudied segment of the caregiving population. The current study (N=166) investigated the mediating role of home care hours on the association between primary caregiving stressors (care recipient [CR] levels of cognitive and functional impairment) and LDCs’ perceived strain (perceived interference of caregiving with other family responsibilities and work). Results from path analyses showed that home care hours fully mediated the negative effect of CRs’ functional impairment on family interference and the negative effect of CRs’ cognitive impairment on work interference. Further, the negative effect of CRs’ cognitive impairment on family interference was partially mediated by home care hours. Thus, a mediating role of home care service hours in the associations between objective stressors and LDC strain was established for both family and work domains. Findings highlight the potential of home care services in alleviating strain in LDCs of community-dwelling CRs.

Predictors and trajectories of ED visits among patients receiving palliative home care services: findings from a time series analysis (2013-2017)

BackgroundCurrent policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits. The Italian health care system had implemented integrated palliative home care (IHPC) services to guarantee a comprehensive, coordinated approach across different actors and to reduce potentially avoidable ED visits. This study aimed to analyze the trajectories of ED visit rates among patients receiving IHPC in the Italian healthcare system, as well as the association between socio-demographic, health supply, and clinical factors.MethodsA pooled, cross-sectional, time series analysis was performed in a large Italian region in the period 2013–2017. Data were taken from two databases of the official Italian National Information System: Home Care Services and ED use. A clinical record is opened at the time a patient is enrolled in IHPC and closed after the last service is provided. Every such clinical record was considered as an IHPC event, and only ED visits that occurred during IHPC events were considered.ResultsThe 20,611 patients enrolled in IHPC during the study period contributed 23,085 IHPC events; ≥1 ED visit occurred during 6046 of these events. Neoplasms accounted for 89% of IHPC events and for 91% of ED visits. Although there were different variations in ED visit rates during the study period, a slight decline was observed for all diseases, and this decline accelerated over time (b = − 0.18, p = 0.796, 95% confidence interval [CI] = − 1.59;1.22, b-squared = − 1.25, p < 0.001, 95% CI = -1.63;-0.86). There were no significant predictors among the socio-demographic factors (sex, age, presence of a non-family caregiver, cohabitant family members, distance from ED), health supply factors (proponent of IHPC) and clinical factors (prevalent disorder at IHPC entry, clinical symptoms).ConclusionOur results show that use of ED continues after enrollment in IHPC, but the trend of this use declines over time. As no significant predictive factors were identified, no specific interventions can be recommended on which the avoidable ED visits depend.

A cross-sectional study of Swiss ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model

BackgroundMultimorbidity is frequently encountered in primary care and is associated with increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients’ use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen’s model to explore factors associated with this use.MethodIn a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model: predisposing factors (patient’s demographics), enabling factors (health literacy (HLS-EU-Q6), deprivation (DipCare)), and need factors (patient’s quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions, and of medications). Logistic regressions (dichotomous variables) and negative binomial regressions (count variables) were calculated to identify predictors of multimorbid patients’ healthcare use.ResultsAnalyses included 843 multimorbid patients; mean age 73.0 (SD 12.0), 28–98 years old; 48.3% men; 15.1% (127/843) used homecare. Social deprivation (OR 0.75, 95%CI 0.62–0.89) and absence of an informal caregiver (OR 0.50, 95%CI 0.28–0.88) were related to less homecare services use. The use of other allied health services (34.9% (294/843)) was associated with experiencing pain (OR 2.49, 95%CI 1.59–3.90). The number of contacts with a GP (median 11 (IQR 7–16)) was, among other factors, related to the absence of an informal caregiver (IRR 0.90, 95%CI 0.83–0.98). The number of specialists involved (mean 1.9 (SD 1.4)) was linked to the treatment burden (IRR 1.06, 95%CI 1.02–1.10).ConclusionMultimorbid patients in primary care reported high use of ambulatory healthcare services variably associated with the Andersen model’s factors: healthcare use was associated with objective medical needs but also with contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patient profiles.

Trajectories of health system use and survival for community-dwelling persons with dementia: a cohort study

ObjectivesTo determine the long-term trajectories of health system use by persons with dementia as they remain in the community over time.DesignPopulation-based cohort study using health administrative data.SettingOntario, Canada from 1...

Publicly funded home care service use in the first 2 years after spinal cord injury in Ontario, Canada

ABSTRACTThe objectives of this study were to describe home care utilization and costs in community-dwelling individuals 2 years post-spinal cord injury (SCI) in Ontario, Canada. This retrospective incident cohort study uses administrative health care data to identify individuals with traumatic SCI (tSCI). Time to service delivery and frequency of service delivery and costs were calculated. A total of 798 individuals with tSCI comprised the cohort. In the first 2 years, personal support/homemaking was the most utilized service. Median cumulative home care 2 years post-discharge was $7,200 ($1,240–35,410 25–75% interquartile range). This study highlights the importance of home care to individuals with SCI.

Characteristics of Young-Onset and Late-Onset Dementia Patients at a Remote Memory Clinic

Young-onset dementia (YOD) is defined as the onset of dementia symptoms before the age of 65 years and accounts for 2-8% of dementia. YOD patients and their caregivers face unique challenges in diagnosis and management. We aimed to compare the characteristics of rural YOD and late-onset dementia (LOD) patients at a rural and remote memory clinic in Western Canada. A total of 333 consecutive patients (YOD = 61, LOD = 272) at a rural and remote memory clinic between March 2004 and July 2016 were included in this study. Each patient had neuropsychological assessment. Health, mood, function, behaviour and social factors were also measured. Both groups were compared using χ2 tests and independent sample tests. YOD patients were more likely to be married, employed, current smokers and highly educated. They reported fewer cognitive symptoms, but had more depressive symptoms. YOD patients were less likely to live alone and use homecare services. YOD caregivers were also more likely to be a spouse and had higher levels of distress than LOD caregivers. Both YOD and LOD patient groups were equally likely to have a driver's licence. Our findings indicate YOD and LOD patients have distinct characteristics and services must be modified to better meet YOD patient needs. In particular, the use of homecare services and caregiver support may alleviate the higher levels of distress found in YOD patients and their caregivers. Additional research should be directed to addressing YOD patient depression, caregiver distress and barriers to services.

Effects of Copayment in Long-Term Care Insurance on Long-Term Care and Medical Care Expenditure

ObjectiveThis study aimed to clarify the difference in (1) long-term care (LTC) usage and expenditure and (2) medical care service usage and expenditure before and after the change in the copayment limit for qualifying individuals from 10% to 20%. Setting and ParticipantsThis quasi-experimental longitudinal design used the database from 1 prefecture of Japan that included 570,434 person-month records of 23,879 insured individuals (in August 2014) who used LTC services between August 2014 and July 2015 and were aged 65 years and older on August 1, 2014. MethodsWe conducted difference-in-difference estimations to compare “before” and “after” outcome differences between insured individuals whose LTC copayment increased to 20% and those whose copayment remained at 10%. Sex, age, Care Needs Level, subsidy, and public assistance were adjusted in the models, along with robustness checks. ResultsDifferences in both insurer's payment and insured's copayment indicated statistical significance between those whose copayment increased and those whose copayment did not increase. We found no significant difference in the number of minutes of home care service use, days of facility care service use, and LTC expenditures among those with copayment increases as well as those with no increase in copayment following the insured's copayment increase policy implementation. In contrast, the policy implementation caused significant differences in the number of days of hospitalization, medical care expenditures, and total expenditures. Conclusions and ImplicationsThe increase in insured individuals' copayment decreased LTC insurer's payment. However, total LTC expenditure increased over time although the increase trend slowed down in the treatment group after the copayment increase policy implemented. Besides, medical care expenditure increased consistently among insured individuals whose copayment increased. As there appears to be a “balloon effect” between LTC and medical care services, it is important to discuss the medical care system while considering the LTC insurance system comprehensively.

The Multidimensional Prognostic Index in general practice: One-year follow-up study.

Older patients' health problems in general practice (GP) can often not be assigned to a specific disease, requiring a paradigm shift to goal-oriented, personalised care for clinical decision making. To investigate the predictive value of the comprehensive geriatric assessment (CGA)-based Multidimensional Prognostic Index (MPI) in a GP setting with respect to the main healthcare indicators during the 12months following initial evaluation. One hundred twenty-five consecutive patients aged 70years and older were enrolled in a GP and followed up to one year. All patients underwent a CGA based on which the MPI was calculated and subdivided into three risk groups (MPI-1, 0-0.33=low risk, MPI-2, 0.34-0.66=moderate risk and MPI-3, 0.67-1, severe risk). Grade of Care (GC), hospitalization rate, mortality, nursing home admission, use of home care services, falls, number of general practitioner contacts (GPC), of geriatric resources (GR) and geriatric syndromes (GS) during the 12 months following initial evaluation were collected. The MPI was significantly associated with number of GS (P<.001), GR (P<.001), GC (P<.001) as well as with the average number of GPC per year (mean 10.4, P=.046). Interestingly, the clinical judgement of the general practitioner, in this case knowing his patients for 16 years on average, was associated with adverse outcomes to a similar extent than the prediction offered by the MPI (GP/adverse outcomes and MPI/adverse outcomes P < .001). The MPI is strongly associated with adverse outcomes in older GP patients and strongly predicts the number of GPC up to one year after initial evaluation. Considering the feasibility and the strong clinimetric properties of the MPI, its collection should be encouraged as early as possible to disclose risk conditions, implement tailored preventive strategies and improve cost-effectiveness of healthcare resources use.

Young people in aged care: trends in the use of aged care services by younger Australians, 2008–2016

Purpose : To determine incidence rate of aged care service use between 2008–2009 and 2015–2016 by younger Australians and the yearly rate of change. Material and methods A population-based epidemiological study was conducted using publicly available datasets from the Australian Institute of Health and Welfare and Australian Bureau of Statistics. The incidence of service utilization by younger people (<65 year) and per 10,000 citizens 0–49, 50–54, 55–59, and 60–64 years old per year was estimated. Negative binomial regression models were used to estimate incidence rate ratios. Results Between 2008–2009 and 2015–2016 the number of younger people accessing services increased for home care services by 103.2% and transition care by 131.9% but decreased for permanent residential care by 0.4%, and respite care by 2.4%. Permanent residential care incidence use decreased for the overall population (incidence rate ratio = 0.98, p < 0.001) and in those 55–59 years old (incidence rate ratio = 0.97, p < 0.001) and for respite care incidence use decreased in those 0–49 years old (incidence rate ratio = 0.93, p = 0.001). The incidence use of home care increased in the overall group (incidence rate ratio = 1.04, p < 0.001) and in those 50–54 (1.08, p < 0.001) and in those 55–59 years old (incidence rate ratio = 1.03, p < 0.001). The use of transition care services increased significantly in all age groups (overall incidence rate ratio = 1.09, p < 0.001). Conclusions The overall use of permanent residential care has decreased along with the use of respite in the youngest people, and the use of home and transition care services have increased. Efforts to keep young people out of residential aged care may have redirected them to home care services. Implications for rehabilitation The number of young people (<65 years old) with disability using aged cares services in Australia has increased significantly between 2008–2009 and 2015–2016. The overall use of permanent residential care has decreased along with the use of respite care, and the use of home and transition care services have increased, which should be encouraged. Development of targeted rehabilitation support programs to support young people with disability housed in residential aged care may help to better cater their care needs. Development of transition pathways to shift young people with disability to appropriate support programs may help to reduce the number of younger people with disability in aged care services.

Investigating the relationship between formal and informal care: An application using panel data for people living together.

There is limited evidence on the relationship between formal and informal care using panel data in a U.K. setting and focused specifically on people living together (co-residents). Using all 18 waves of the British Household Panel Survey (1991-2009), we analyse the effect of informal care given by co-residents on the use of formal home care and health care services more generally. To account for endogeneity, we estimate models using random effects instrumental variable regression using the number of daughters as a source of exogenous variation. We find that a 10% increase in the monthly provision of informal care hours decreases the probability of using home help (formal home care) by 1.02 percentage points (p<.05), equivalent to a 15.62% relative reduction. This effect was larger for home help provided by the state (β=-.117) compared with non-state home help (β=-.044). These results provide evidence that significant increases in the supply of informal care would reduce the demand for home-help provision.

P.003 Differences between younger and older dementia patients at a rural and remote memory clinic

Background: Young-onset dementia (YOD) patients and their caregivers face unique challenges in diagnosis and management. We aimed to compare the characteristics of rural YOD and late-onset dementia (LOD) patients. Methods: A total of 333 consecutive patients (YOD=61, LOD=272) at a rural and remote memory clinic between March 2004 and July 2016 were included in this study. Each patient had neuropsychological assessment. Health, mood, function, behaviour, and social factors were also measured. Both groups were compared using χ2 tests and independent sample tests. Results: YOD patients were more likely to be married, employed, current smokers, and highly educated. They reported fewer cognitive symptoms, but had more depressive symptoms. YOD patients were less likely to live alone and use homecare services. YOD caregivers were also more likely to be a spouse and had higher levels of distress than LOD caregivers. Conclusions: Our findings indicate YOD and LOD patients have distinct characteristics and services must be modified to better meet YOD patient needs. In particular, the use of homecare services and caregiver support may alleviate the higher levels of distress found in YOD patients and their caregivers. Additional research should be directed to addressing YOD patient depression, caregiver distress, and barriers to services.

Visual impairment and the use of formal and informal home care in Canada: the Canadian Longitudinal Study on Aging

ObjectiveTo determine the use of home care services in those with and without visual impairment in Canada. DesignPopulation-based cross-sectional study. ParticipantsParticipants came from the baseline examination of the Canadian Longitudinal Study on Aging Comprehensive Cohort. Inclusion criteria included age between 45 and 85 years, community dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. People were excluded if they were in an institution, were living on a First Nations reserve, were full-time members of the Canadian Armed Forces, did not speak French or English, or had cognitive impairment. MethodsPresenting visual acuity was measured using the Early Treatment of Diabetic Retinopathy Study chart at 2 meters. Visual impairment was defined as binocular acuity worse than 20/60. The use of formal, informal, and both types of home care was determined by questionnaire. ResultsFor 29 666 participants, the use of any home care was greater in those with visual impairment than in those without (28% vs 12%, respectively, p < 0.01). After adjusting for demographics and health, people with visual impairment were more likely to use informal home care (odds ratio [OR] = 1.89, 95% CI 1.35–2.63) and formal home care/both types of home care (OR = 2.70, 95% CI 1.79–4.07) than those without visual impairment. Marital status was a modifier. ConclusionVisual impairment is associated with use of home care services. These findings warrant further exploration and, if confirmed, have major health service implications, given the rising prevalence of visual impairment due to age-related eye diseases.

Domiciliary dental care among homebound older adults: A nested case-control study in Japan.

Improving the availability of dental care is essential to maintain older adults' general health and wellbeing. Domiciliary dental care is a feasible alternative. The present study aimed to investigate factors affecting the use of domiciliary dental care among home-dwelling dependent older adults. A retrospective nested case-control study was carried out. We identified long-term care recipients who used home care services between April 2012 and March 2014 using Japan's nationwide long-term care service claim database. One-to-one case-control matching was carried out between those with and without domiciliary dental care, based on sex, age and the time home care service use was started. We carried out multivariable conditional logistic regression analyses to assess various factors associated with using domiciliary dental care. We identified 3 377 998 eligible homebound long-term care beneficiaries aged ≥65 years. Of these, 278 302 (8.2%) received domiciliary dental care. Factors associated with a higher probability of receiving domiciliary dental care were: higher level of care need (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.93-2.06), exemption from out-of-pocket payment (OR 1.35, 95% CI 1.32-1.39]), living in a group home (OR 7.93, 95% CI 7.71-8.16), using other domiciliary services such as physician visits (OR 3.15, 95% CI 3.08-3.22) and a large number of dental clinics providing domiciliary dental care in their municipality (OR 1.74, 95% CI 1.70-1.77). Significant barriers to receiving domiciliary dental care were living alone (OR 0.64, 95% CI 0.62-0.66) and dementia (OR 0.89, 95% CI 0.88-0.91). Our findings might help to improve the availability of dental care in this population. Geriatr Gerontol Int 2019; 19: 679-683.

Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia.

The needs of older lesbian and gay people regarding access and use of aged-care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and experiences of residential aged-care and home-based aged-care services in Australia. The focus of this paper is their preparedness for using aged-care services. The results highlight that participants had a number of concerns related to accessing residential-care services in particular, including perceptions of a lack of inclusivity and concerns of potential for discrimination and hostility, loss of access to community and partners, decreased autonomy and concerns relating to quality of care and the potential for elder abuse. Participants noted a number of strategies they employed in avoiding residential-care services, including the use of home-care services, renovating the home for increased mobility, moving to locations with greater access to outside home-care services, a preference for lesbian/gay-specific housing and residential-care options if available, and the option of voluntary euthanasia to ensure dignity and autonomy. Participants, on the whole, were hopeful that they would never require the use of residential-care services, with some believing that having current good health or the support of friends could prevent this from happening. The findings suggest that older lesbian and gay people have a variety of concerns with aged-care and may need additional support and education to improve their perceptions and experiences of services, whether these are needed presently or in the future.

Home care service utilisation by people with dementia-A retrospective cohort study of community nursing data in Australia.

Progressive aged care reforms are shifting dementia care into the community. These efforts have been shown to prevent transition to residential aged care facilities and hospitals. There is a paucity of studies examining the utilisation of home care services for people living with dementia. This study aims to address the current knowledge gap by providing a comprehensive summary of older adults receiving home care and comparing service use for people with and without dementia. A retrospective secondary data analysis was conducted using routine data prospectively collected from a cohort (n=2,703 with dementia matched to 9,224 without dementia; total 11,927) using a community home nursing service in metropolitan Melbourne, Australia, in 2014. Descriptive statistics compared individuals with and without dementia on client-level demographics and their episode of home care service use. A comparative analysis on select variables was also performed using a conditional Poisson regression to estimate relative risk (RR). Compared to older adults without dementia, people with dementia were more likely to be born overseas (RR 1.10, 95% CI [1.03-1.19]), require an interpreter (RR 1.41, 95% CI [1.26-1.59]), and live with family (RR 1.09 [1.01-1.16]). When examining an individual's episode of care, people with dementia were more likely to require acute care (RR 1.07, 95% CI [1.01-1.14]) and be discharged from home care with personal care services (RR 1.46, 95% CI [1.24-1.72]). People with dementia were less likely to be referred from a hospital (RR 0.73, 95% CI [0.69-0.77]), achieve their home care goals (RR 0.91, 95% CI [0.87-0.94]), or die while in receipt of home care services (RR 0.82, 95% CI [0.72-0.94]). Our findings suggest that people with dementia have different socio-demographic characteristics and interactions with home care services compared to people without dementia.

Use of home care services in a cohort of older adults resident in Lazio region, Italy

Use of home care services in a cohort of older adults resident in Lazio region, Italy

Active identification of patients appropriate for palliative care: Impact on use of palliative care and home care resources.

101 Background: This research evaluates whether active identification of patients who may benefit from a palliative approach to care changes the use of palliative care and home care services. Methods: Between 2014 and 2017, Cancer Care Ontario implemented the INTEGRATE project at 4 cancer centres and 4 primary care teams. Physicians in participating sites were encouraged to systematically identify patients who were likely to die within 1 year and would benefit from a palliative approach to care. Patients in the INTEGRATE intervention group were 1:1 matched to non-intervention controls selected from provincial healthcare administrative data based on a publicly funded health system using the propensity score-matching. Palliative care and home care services utilization was evaluated within 1 year after the date of identification (index date), censoring on death, or March 31, 2017, the study end date. Cumulative incidence function was used to estimate the probability of having used care services, with death as a competing event. Rate of service use per 360 patient-days was calculated. Analyses were done separately for palliative care and home care. Results: Of the 1,187 patients in the INTEGRATE project, 1,185 were matched to a control. The intervention and the control groups were well-balanced on demographics, diagnosis, comorbidities, and death status. The probability of using palliative services in the intervention group was 80.3%, which was significantly higher than that in the control group (62.4%) with more palliative care visits in the intervention group [29.7 (95%CI: 29.4 to 30.1] per 360 patient-days) than in the control group [19.6 (95%CI: 19.3 to 19.9) per 360 patient-days]. The intervention group had a greater probability of receiving home care (81.4%) than the control group (55.2%) with more homecare visits per 360 patient-days [64.7 (95%CI: 64.2 to 65.3) vs. 35.3 (95%CI: 34.9 to 35.7)] The intervention group also had higher physician home visits as compared to the control group (36.5% vs. 23.7%). Conclusions: Physicians actively identifying patients that would benefit from palliative care resulted in increased use of palliative care and home care services.

Using the Multidimensional Prognostic Index to Predict Clinical Outcomes of Hospitalized Older Persons: A Prospective, Multicenter, International Study

Multidimensional Prognostic Index (MPI) is useful as a prognostic tool in hospitalized older patients, but our knowledge is derived from retrospective studies. We therefore aimed to evaluate in a multicenter, longitudinal, cohort study whether the MPI at hospital admission is useful to identify groups with different mortality risk and whether MPI at discharge may predict institutionalization, rehospitalization, and use of home care services during 12 months. This longitudinal study, carried out between February 2015 and August 2017, included nine public hospitals in Europe and Australia. A standardized comprehensive geriatric assessment including information on functional, nutritional, cognitive status, risk of pressure sores, comorbidities, medications, and cohabitation status was used to calculate the MPI and to categorize participants in low, moderate, and severe risk of mortality. Data regarding mortality, institutionalization, rehospitalization, and use of home care services were recorded through administrative information. Altogether, 1,140 hospitalized patients (mean age 84.1 years, women = 60.8%) were included. In the multivariable analysis, compared to patients with low risk group at admission, patients in moderate (odds ratio [OR] = 3.32; 95% CI: 1.79-6.17; p < .001) and severe risk (OR = 10.72, 95% CI: 5.70-20.18, p < .0001) groups were at higher risk of overall mortality. Among the 984 older patients with follow-up data available, those in the severe-risk group experienced a higher risk of overall mortality, institutionalization, rehospitalization, and access to home care services. In this cohort of hospitalized older adults, higher MPI values are associated with higher mortality and other negative outcomes. Multidimensional assessment of older people admitted to hospital may facilitate appropriate clinical and postdischarge management.

Effect of the economic crisis on the use of health and home care services among elderly Spanish diabetes patients

AimsTo describe the utilization of health and home care services among older people (≥65 years) with diabetes during the economic crisis; to identify the factors associated with changes in the utilization of these services; and to study the time trends (2009–2014). MethodsWe used the European Health Interview Surveys for Spain (EEHSS) for 2009/10 and 2014. The dependent variables included self-reported hospitalizations; general practitioner (GP) visits; ‘other healthcare services’ (OHS) used; and home care services (HCS) used. ResultsWe identified 6026 and 6020 diabetic patients (EEHSS2009 and EEHSS2014, respectively). A significant decrease in the number of GP visits (OR 0.94; 95% CI 0.91–0.98) and the use of HCS (OR 0.95; 95% CI 0.91–0.99) was found; however, we found an increase in the use of OHS (OR 1.06; 95% CI 1.02–1.10). Multivariate models showed that factors associated with an increased use included chronic conditions, worse self-rated health, pain and mental disorders. Physical activity was a strong predictor of lower hospitalizations and HCS use. Female gender was associated with significantly lower hospitalizations and a higher use of OHC and HCS. ConclusionWe found a decrease in the number of GP visits and the use of HCS among elderly diabetic adults; however, we also observed an increase in the use of OHS, which may partly explain this decrease in the figures. Significant differences in the use of health services were found according to gender. The effect of the economic crisis, if any, seems to have had a small magnitude.

Use of home care services among adults with intellectual and developmental disabilities: does where you live matter?

ABSTRACTHome care services are a growing segment of the health care system that support the ageing population in developed nations. In Canada, adults with intellectual and developmental disabilities, living in the community, in a group home, on their own, or with a partner or family, are eligible for home care. This study sought to determine whether (1) home care services received differed based on type of residence, and (2) if, after controlling for other factors, this relationship was modified by geographic region. Secondary analyses of population-level data (2003–2015) were conducted using a cohort of 4456 home care users with developmental disabilities in Ontario (Canada). Logistic regression informed the relationship between residence, region, and home care services used. Home care users with intellectual and developmental disabilities living in group homes were older, had more cognitive and functional impairment, and were more frail. Controlling for these, type of residence was not associated with receiving nursing and therapy services, but it interacted with age and frailty in predicting receipt of meal services. Region modified the effect of residence on receipt of home health aide and homemaking services. Where people live mattered for some but not all services. While similar use of home care services was observed across regions, very different patterns emerged for those living in group homes. Future work is needed to better understand how sectors (home care and developmental and social services) come together to support adults with intellectual and developmental disabilities in the community.