There is the desire amongst elderly Canadians to remain living at home, maintaining their independence. As the population ages, the health care system is faced with the challenge of allocating limited resources. Home care in Ontario is provided through Community Care Access Centres (CCAC) or Community Support Agencies (CSA). This study made comparisons among CSA clients (using the interRAI-Community Health Assessment, n=796), a sub-population of CCAC clients with lighter-care needs (n=8163) and all other CCAC clients (n=31,078), both using the Minimum Data Set-Home Care (MDS HC). The majority of clients in all groups were female, widowed, and spoke English as their primary language. CCAC clients had more health conditions than did CSA clients. Light-care CCAC clients received less hours of formal support than other CCAC clients and were less likely to have informal support caregivers who reported caregiver burden. Between 1998 and 2005, Ontario provided services to an increasingly impaired home care population, although overall impairment among home care client remained low. For the purposes of benchmarking, MDS HC data from Ontario was compared with MDS HC data from 11 European countries and was found to fall within the range of the other countries in terms of average impairment level of home care clients. Logistic regression was used to predict the likelihood of receiving CCAC services. Not being self-reliant, having decline in activities of daily living, having experienced falls, self-reporting one's health to be poor and reporting less loneliness were all correlates for CCAC service use. Implications and direction for future research were discussed.

There is the desire amongst elderly Canadians to remain living at home, maintaining their independence. As the population ages, the health care system is faced with the challenge of allocating limited resources. Home care in Ontario is provided through Community Care Access Centres (CCAC) or Community Support Agencies (CSA). This study made comparisons among CSA clients (using the interRAI-Community Health Assessment, n=796), a sub-population of CCAC clients with lighter-care needs (n=8163) and all other CCAC clients (n=31,078), both using the Minimum Data Set-Home Care (MDS HC). The majority of clients in all groups were female, widowed, and spoke English as their primary language. CCAC clients had more health conditions than did CSA clients. Light-care CCAC clients received less hours of formal support than other CCAC clients and were less likely to have informal support caregivers who reported caregiver burden. Between 1998 and 2005, Ontario provided services to an increasingly impaired home care population, although overall impairment among home care client remained low. For the purposes of benchmarking, MDS HC data from Ontario was compared with MDS HC data from 11 European countries and was found to fall within the range of the other countries in terms of average impairment level of home care clients. Logistic regression was used to predict the likelihood of receiving CCAC services. Not being self-reliant, having decline in activities of daily living, having experienced falls, self-reporting one's health to be poor and reporting less loneliness were all correlates for CCAC service use. Implications and direction for future research were discussed.

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2013-06-27 12:24:53.085