While some individuals can successfully age at home, others with similar levels of need may require facility based long-term care (LTC). The question addressed in this thesis is: “What factors determine whether or not older persons age at home?” I argue that in addition to the characteristics and care needs of individuals (the demand side); access to home and community care (H&CC) at the local level (the supply side) determines whether or not older people receive care at home relative to other settings. In emphasizing the role of the supply side, I draw on Neoinstitutional Theory and the Theory of Human Ecology to examine how institutions of the state (policies, norms, values, and organizational structures) facilitate or constrain opportunities to age at home across urban and rural areas. In conducting my analysis I draw on the Balance of Care (BoC) framework to analyze the characteristics of individuals waiting for LTC placement in Thunder Bay (urban community) and the surrounding Region (rural communities) of Northwestern Ontario. The BoC framework provides the means to estimate the extent to which their needs could potentially be met in the community if home and community care (H&CC) services were available. The results show that individuals waiting for LTC placement in Thunder Bay experienced higher levels of impairment than those in the Region. However in both areas, most individuals required assistance with instrumental activities of daily living (e.g. housekeeping, meal preparation, etc). In both areas there was limited access to informal caregivers. If a H&CC package were to be made available, 8% of those waiting for facility based LTC in Thunder Bay could potentially be supported safely and cost-effectively at home compared to 50% in the surrounding Region. The results confirm that the supply side matters. When H&CC cannot be accessed, LTC may become the default option, particularly in rural and remote areas. If given access to H&CC, a significant proportion of individuals can potentially age at home.

While some individuals can successfully age at home, others with similar levels of need may require facility based long-term care (LTC). The question addressed in this thesis is: “What factors determine whether or not older persons age at home?” I argue that in addition to the characteristics and care needs of individuals (the demand side); access to home and community care (H&CC) at the local level (the supply side) determines whether or not older people receive care at home relative to other settings. In emphasizing the role of the supply side, I draw on Neoinstitutional Theory and the Theory of Human Ecology to examine how institutions of the state (policies, norms, values, and organizational structures) facilitate or constrain opportunities to age at home across urban and rural areas. In conducting my analysis I draw on the Balance of Care (BoC) framework to analyze the characteristics of individuals waiting for LTC placement in Thunder Bay (urban community) and the surrounding Region (rural communities) of Northwestern Ontario. The BoC framework provides the means to estimate the extent to which their needs could potentially be met in the community if home and community care (H&CC) services were available. The results show that individuals waiting for LTC placement in Thunder Bay experienced higher levels of impairment than those in the Region. However in both areas, most individuals required assistance with instrumental activities of daily living (e.g. housekeeping, meal preparation, etc). In both areas there was limited access to informal caregivers. If a H&CC package were to be made available, 8% of those waiting for facility based LTC in Thunder Bay could potentially be supported safely and cost-effectively at home compared to 50% in the surrounding Region. The results confirm that the supply side matters. When H&CC cannot be accessed, LTC may become the default option, particularly in rural and remote areas. If given access to H&CC, a significant proportion of individuals can potentially age at home.

Thesis (M.N.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Nursing, Nursing. Title from pdf file main screen (viewed on April 28, 2010). Includes bibliographical references.

The concept of Shifting the Balance of Care was first introduced to NHS Scotland in 2005 through the Kerr Report. The key messages from the report were to: ensure sustainable and safe local services, which are supported by the right skills, change the emphasis of care into the community, provide preventative reactive care, and fully integrate the system to tackle the changes, use technology more effectively, and involve the public in finding solutions to change. Following the report, a framework was developed which highlighted and prioritised eight areas of improvement. These areas for improvement are the focus by which this research examines if Operational Research (OR), specifically OR models, can have a positive impact in Shifting the Balance of Care. The research utilises underlying OR methodologies and methods and provides evidence from the literature of the ability of nine selected models to facilitate the Shift in the Balance of Care. A contributing factor to the research is the barriers to implementation of OR models into the NHS. With reference to the literature, the common barriers to implementation of OR models are categorised and used to provide direction to modellers where implementation barriers are more prevalent in some models than in others. The research also provides empirical evidence of three selected models’ (the Lean Methodology, Process Mapping and Simulation, developed over two Case Studies) ability to address and influence the prioritised Improvement Areas, with the addition of a newly developed model: SoApt. The development of SoApt follows the Principles of Model Development derived as a guide to modellers who wish to develop a new model. SoApt is also empirically explored in a Case Study and provides some evidence of the models ability to aid Decision-makers, faced with limited budgets, to choose between options which will Shift the Balance of Care. OR methods and methodologies are examined to ascertain the Roles of Models for each model explored in the Case Studies. Examination of the Roles of Models against the Improvement Areas provided evidence of a models’ ability to address more than one of the priority areas and that models can be used together or sequentially. In addition, with reference to OR methods and methodologies, a theoretical Evaluation Framework is proposed which suggests the User and User Satisfaction is key to the evaluation of a model’s success; positive experiences of the User and Use of the model may help to eliminate some of the barriers to implementation.