Care Outcomes in Long-Term Care Facilities in British Columbia, Canada

McGregor, Margaret J.; Tate, Robert B.; McGrail, Kimberlyn; Ronald, Lisa A.; Broemeling, Anne-Marie; Cohen, Marjorie Griffin

doi:10.1097/01.mlr.0000223477.98594.97

Cited by 66 publications

(73 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The method of assessing fluid intake or hydration status was judged low risk of bias in 4 studies, 14,20,22,25 high risk in 16, 10e13,15e19,21,23,24,26,28,32,33 and unclear in 3. 29e31 Of 4 studies judged low risk, 2 assessed serum osmolality, 20,22 1 used International Classification of Diseases, Ninth Revision (ICD-9) codes only, 25 and 1 measured all fluid intake over 24 hours using referenced methodology with good interrater reliability (r ¼ 0.98).…”

Section: Risk Of Bias Validity and Methodological Qualitymentioning

confidence: 99%

“…29e31 Of 4 studies judged low risk, 2 assessed serum osmolality, 20,22 1 used International Classification of Diseases, Ninth Revision (ICD-9) codes only, 25 and 1 measured all fluid intake over 24 hours using referenced methodology with good interrater reliability (r ¼ 0.98). 14 Of the 16 high-risk studies, 8 assessed fluid intake only, 11,15,17,19,23,24,26,33 4 assessed dehydration status, 12,13,21,28 and 4 used a combination of both fluid intake and dehydration assessment.…”

Section: Risk Of Bias Validity and Methodological Qualitymentioning

confidence: 99%

See 1 more Smart Citation

Increasing Fluid Intake and Reducing Dehydration Risk in Older People Living in Long-Term Care: A Systematic Review

Bunn

Jimoh

Wilsher

et al. 2015

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management, and care staff, but these require further investigation using more robust study methodologies. The review protocol was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003100).

show abstract

Section: Risk Of Bias Validity and Methodological Qualitymentioning

confidence: 99%

Section: Risk Of Bias Validity and Methodological Qualitymentioning

confidence: 99%

Increasing Fluid Intake and Reducing Dehydration Risk in Older People Living in Long-Term Care: A Systematic Review

Bunn

Jimoh

Wilsher

et al. 2015

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

show abstract

“…5 This study compared hospital admission rates for 6 care-sensitive diagnoses among British Columbia residents in for-profit and not-for-profit long-term care facilities. Rates of admission because of anemia, pneumonia and dehydration were found to be higher in for-profit facilities than in their not-for-profit counterparts, after adjustment for resident case mix and other potential confounders.…”

Section: How Is the Money Spent?mentioning

confidence: 99%

For-profit versus not-for-profit delivery of long-term care

McGrail¹,

McGregor²,

Cohen³

et al. 2006

Canadian Medical Association Journal

View full text Add to dashboard Cite

P ublic funds can be used to pay for health care services that are delivered either by for-profit or not-for profit agencies. A systematic review of patient outcomes in US hospitals by ownership status showed that not-for-profit hospitals tended to produce better results.1 Although there are no Canadian acute care hospitals in the for-profit sector, the issue of interest here is whether the same trend in outcomes applies to for-profit and not-for-profit ownership of long-term care facilities.About 60% and 30% of all publicly funded long-term care beds in Ontario and British Columbia, respectively, are in forprofit institutions.2,3 The co-existence of for-profit and notfor-profit providers in the same province creates a "natural laboratory" for examining their differences. This is particularly true because the funding paid by the province to these facilities is tied to resident care requirements and thus the same amount is paid per standardized patient whether he or she is in a for-profit or a not-for-profit facility. Despite this, there has been relatively little Canadian research that examines the experiences of residents in these 2 types of facilities. Although there is an abundance of evidence from the United States demonstrating superior performance of the not-forprofit sector in measures of quality of care, there are claims that these findings have limited generalizability in Canada because of differences in the 2 countries' health care systems. However, a few Canadian studies are now starting to provide a portrait of what public investment "buys" in for-profit and not-for-profit facilities. How is the money spent?Long-term care facilities, like hospitals, are labour-intensive; therefore, staffing costs account for a significant portion of total expenditures. Unlike many parts of the United States, Canada has no legislated minimal requirements for staffing in longterm care facilities. Instead, institutions either face requirements for minimum spending in different categories as dictated by "funding envelopes" (as in Ontario), or are free to choose how to apportion their funding (as in British Columbia).There is now increasing evidence that the for-profit and not-for-profit sectors in Canada make different spending decisions. In an Ontario study, government-operated facilities were found to provide more hours of direct patient care per resident than for-profit facilities, although the public-sector facilities also care for residents with greater health needs.2 In British Columbia, not-for-profit facilities were also found to provide more hours of direct patient care per resident than for-profit facilities, with the same funding level from government; this difference remained after adjustment for the size and level of care of the facilities.3 Adjustment for the mix of patients cared for by the 2 types of facilities is important. For example, most extended-care beds, reserved for the care of the frailest elderly patients, are in not-for-profit facilities.What are the outcomes of care?Do differences in staffing...

show abstract

“…At the same time, a variety of Canadian research has shown that staffing levels are lowest in forprofit homes (Berta et al 2005;McGregor et al 2006McGregor et al , 2010. A study of BC facilities found that, between 1996 and 2006, total nursing hours per day increased from 1.95 to 2.13 in for-profit residences, from 1.99 to 2.48 in not-for-profit ones and from 2.25 to 3.30 in public facilities (McGregor et al 2010: Table 3).…”

Section: Security In Qualitymentioning

confidence: 97%

The Threats of Privatization to Security in Long-Term Residential Care

Armstrong

MacLeod

2015

Ageing Int

View full text Add to dashboard Cite

This paper argues that privatization, especially in the form of for-profit, chain ownership, undermines security in old age. Using data from research in Canada and focusing on the specific case of long-term residential care, this paper examines four aspects of security; security of physical access, security of financial access, security of quality and security of employment for those providing care.

show abstract

Care Outcomes in Long-Term Care Facilities in British Columbia, Canada

Cited by 66 publications

References 24 publications

Increasing Fluid Intake and Reducing Dehydration Risk in Older People Living in Long-Term Care: A Systematic Review

Increasing Fluid Intake and Reducing Dehydration Risk in Older People Living in Long-Term Care: A Systematic Review

For-profit versus not-for-profit delivery of long-term care

The Threats of Privatization to Security in Long-Term Residential Care

Contact Info

Product

Resources

About