Policy prescriptions for combating dengue fever tend to focus on addressing environmental and social conditions of poverty. However, while poverty has long been considered a determinant of dengue, the research evidence for such a relationship is not well established. Results of a systematic review of the research literature designed to identify and assess the current state of the empirical evidence for the dengue-poverty link reveal a mixed story. Of 260 peer-reviewed articles referencing dengue-poverty relationships, only 12 English-language studies empirically assessed these relationships. Our analysis covering various social and economic conditions of poverty showed no clear associations with dengue rates. While nine of the 12 studies demonstrated some positive associations between measures of dengue and poverty (measured inconsistently through income, education, structural housing condition, overcrowding, and socioeconomic status), nine also presented null results and five with negative results. Of the five studies relating to access to water and sanitation, four reported null associations. Income and physical housing conditions were more consistently correlated with dengue outcomes than other poverty indicators. The small size of this sample, and the heterogeneity of measures and scales used to capture conditions of poverty, make it difficult to assess the strength and consistency of associations between various poverty indicators and dengue outcomes. At present, the global body of eligible English-language peer-reviewed literature investigating dengue-poverty relationships is too small to support a definitive relationship. We conclude that more research, particularly using standardized measures of both outcomes and indicators, is needed to support evidence-informed policies and approaches.

We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre' s long-stay patients. RésuméNous avons examinés, dans une seule circonscription en Ontario et au moyen des instruments d'évaluation d'interRAI, le cas des bénéficiaires de soins continus financés par les deniers publics qui résident dans trois types d'établissements : les bénéficiaires de soins à domicile de longue durée en appartements et résidences privées, les patients en maisons de retraite et les résidents en foyers de soins de longue durée. Parmi les patients qui reçoivent des soins à domicile, on observe chez les résidents en maisons de retraite une proportion plus élevée de démence et de troubles cognitifs modérés, moins de soutien sous forme de soins informels, moins de soins personnels et des services infirmiers supérieurs à ceux fournis par le système public de soins à domicile, des visites à domicile plus fréquentes mais plus courtes ainsi que des dépenses publiques pour les soins à domicile moins élevées que prévu. Ces dépenses moins élevées peuvent être dues à l' efficience de la prestation des soins ou au fait que les maisons de retraite fournissent certains services qui sont habituellement fournis par le système public de soins à domicile. Bien que les personnes dans chacun de ces établissements soient principalement des aînés qui présentent un haut degré de fragilité et de complexité médicale, les résidents dans les foyers de soins de longue durée présen-tent un bien plus grand besoin de soins. Nous estimons qu' environ 40 % des résidents en maisons[82] HEALTHCARE

Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.

Objective The objective was to compare home care episode, standardised assessment, and service patterns in Ontario’s publicly funded home care system during the first wave of the COVID-19 pandemic (i.e., March to September 2020) using the previous year as reference. Study design and setting We plotted monthly time series data from March 2019 to September 2020 for home care recipients in Ontario, Canada. Home care episodes were linked to interRAI Home Care assessments, interRAI Contact Assessments, and home care services. Health status measures from the patient’s most recent interRAI assessment were used to stratify the receipt of personal support, nursing, and occupational or physical therapy services. Significant level and slope changes were detected using Poisson, beta, and linear regression models. Results The March to September 2020 period was associated with significantly fewer home care admissions, discharges, and standardised assessments. Among those assessed with the interRAI Home Care assessment, significantly fewer patients received any personal support services. Among those assessed with either interRAI assessment and identified to have rehabilitation needs, significantly fewer patients received any therapy services. Among patients receiving services, patients received significantly fewer hours of personal support and fewer therapy visits per month. By September 2020, the rate of admissions and services had mostly returned to pre-pandemic levels, but completion of standardised assessments lagged behind. Conclusion The first wave of the COVID-19 pandemic was associated with substantial changes in Ontario’s publicly funded home care system. Although it may have been necessary to prioritise service delivery during a crisis situation, standardised assessments are needed to support individualised patient care and system-level monitoring. Given the potential disruptions to home care services, future studies should examine the impact of the pandemic on the health and well-being of home care recipients and their caregiving networks.

ome care serves people of all ages and with broad complexities of needs. Home care services may be used to support patient recovery after hospital discharge, or to help patients cope with life-limiting illness or manage chronic conditions, disabilities or mental illnesses, among other functions. 1 The availability of communitybased care options-in conjunction with substantial contributions by unpaid caregivers-makes it possible to support people with care needs at home, thus reducing demand on high-cost hospital and institutional beds. 2-4 Ultimately, the goal of home care is to meet the patient's needs so that they require the same (or lesser) level of care over time; however, frailty has considerable influence on whether this goal can be achieved. Frailty describes a state of vulnerability as a result of agerelated declines in multiple physiologic systems. 5 When faced with a stressor, a frail person is more likely to experience sudden health state changes and is less likely to return to their premorbid health state. In this state of poor recovery, frailty increases the risk of adverse outcomes, such as increased dependency and disability, high health service use and death. 5-7 Emerging evidence about coronavirus disease 2019 (COVID-19) suggests that older people and those with comorbidities (especially of the heart, lung, kidney and liver) A comparison of 3 frailty measures and adverse outcomes in the intake home care population: a retrospective cohort study