Long-term Care Trajectories in Canadian Context: Patterns and Predictors of Publicly Funded Care

Penning, Margaret J.; Cloutier, Denise; Nuernberger, Kim; MacDonald, Stuart W. S.; Taylor, Deanne

doi:10.1093/geronb/gbw104

Cited by 17 publications

(28 citation statements)

References 26 publications

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“…There are several possible explanations. First, there is the possibility that within the public LTC system, those in advanced old age are funneled into institutional (nursing home) rather than community-based LTC settings ( Penning, Cloutier, Nuernberger, MacDonald, & Taylor, 2016 ) and, in the process, into a trajectory that will see their lives come to an end within the nursing home itself. In addition, as noted by Forma et al (2007, p. 152), “regardless of need, older age groups may have fewer admissions to inpatient hospital care than younger ones because they are less likely admitted and less intensive care is given for them” (see Levinsky et al, 2001 ).…”

Section: Discussionmentioning

confidence: 99%

“When I Said I Wanted to Die at Home I Didn’t Mean a Nursing Home”: Care Trajectories at the End of Life

Penning

Cloutier

Nuernberger

et al. 2017

Innovation in Aging

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Background and ObjectivesLittle is known regarding the care trajectories older adults experience at the end of life (EOL). We drew on a structural/institutional life course perspective to examine the trajectories evident among older adults transitioning through the Canadian formal long-term care system. The sequence of care transitions as well as the impact of social location, social and economic resources, and health-related factors on these trajectories were examined.Research Design and MethodsTo identify EOL care trajectories, we used administrative data collected on older adults (aged 65+) who received publicly subsidized long-term care services (e.g., nursing home and home and community-based care) in one health region in British Columbia, Canada from January 1, 2008 through December 31, 2011 and who died by March 31, 2012 (n = 11,816). Multinomial logistic regression analyses assessed the impact of selected covariates on these trajectories.ResultsThe majority of those studied (65.4%) died outside of acute hospital settings. The most common trajectories involved transitions from home care to nursing home/residential care to non-hospital death (39.5%) and transitions from in-home care to hospital death (22.4%). These and other trajectories were shaped by social structural factors, access to social and economic resources, as well as health status and prior hospitalizations.Discussion and ImplicationsDespite calls for minimizing hospital-based deaths and maximizing home-based deaths, older LTC recipients often experience EOL care trajectories that end in death in a nursing home care setting. Our findings point to the value of a structural/institutional life course perspective in informing an understanding of who experiences this and other major EOL care trajectories. In doing so, they also provide direction for policy and practice designed to address inequalities and enhance the quality of EOL care.

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Section: Discussionmentioning

confidence: 99%

“When I Said I Wanted to Die at Home I Didn’t Mean a Nursing Home”: Care Trajectories at the End of Life

Penning

Cloutier

Nuernberger

et al. 2017

Innovation in Aging

Self Cite

View full text Add to dashboard Cite

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“…When it comes to understanding the aging process much of the early data were obtained from residents within the United States. Numerous single country investigations followed that also focused on a specific age-related issue [15][16][17][18][19]. The current study expands upon existing research using single-location data that often cannot be generalized from one culture to another.…”

Section: Introductionmentioning

confidence: 96%

Exploring Cultural Similarity and Cultural Diversity: A Cross-National Study of Nine Countries

Karlin¹,

Weil²

2019

J Aging Sci

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“…A few studies offer insights into family and friend caregiver experiences [32][33][34][35], including their interactions with the health and/or long term care system [36,37], helping us to start to comprehend older adult care pathways over time. While medical care is most commonly delivered by professionals, family and friend caregivers provide many other necessary supports including transportation, help with domestic tasks and home maintenance duties, and emotional support [2,38].…”

Section: Introductionmentioning

confidence: 99%

Home care clients: a research protocol for studying their pathways

Keefe

Funk

Knight

et al. 2020

BMC Health Serv Res

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Background: Enhancing non-clinical home care supports and services for older adults to live well is a strategic priority in developed countries, including Canada. Underpinning these supports and services are structures of care that are reflected in home care policies, programs and practices within jurisdictions. These approaches to care exist at multiple levels and inform interactions, perceptions, and care assessment, planning and provision, ultimately shaping the supports that are delivered. Jurisdictional differences in approaches to care mean that pathways through home care systems may differ, depending on where one lives. The goal of this study is to understand how approaches to care shape the pathways of older adult home care clients with chronic and long term conditions in two Canadian health jurisdictions. Methods: This longitudinal mixed-methods study has three interrelated research streams informed by aspects of the socio-ecological framework. We will examine client pathways using a retrospective analysis of home care assessment data (Resident Assessment Instrument-Home Care) in two health authorities (Client/Service Data Stream). We will analyze interview data from older adult home care clients and a cluster of each client's family or friend caregiver(s), home support worker(s), care/case coordinator(s) and potentially other professionals at up to three points over 18 months using a prospective qualitative comparative case study design (Constellation Data Stream). We will review home care policies relevant to both health authorities and interview key informants regarding the creation and implementation of policies (Policy Stream). Our study will apply an integrated knowledge translation (iKT) approach that engages knowledge users in research design, analysis and interpretation to facilitate relevancy of results. Discussion: Applying a mixed-method research design to understand approaches to care within and between two jurisdictions will contribute to the evidence base on older adult home care client pathways. Study results will identify how potential differences are experienced by clients and their families. An understanding of the policies will help to contextualize these findings. The iKT model will ensure that findings are useful for strategic planning and decisionmaking, and supporting changes in care practice.

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Long-term Care Trajectories in Canadian Context: Patterns and Predictors of Publicly Funded Care

Cited by 17 publications

References 26 publications

“When I Said I Wanted to Die at Home I Didn’t Mean a Nursing Home”: Care Trajectories at the End of Life

“When I Said I Wanted to Die at Home I Didn’t Mean a Nursing Home”: Care Trajectories at the End of Life

Exploring Cultural Similarity and Cultural Diversity: A Cross-National Study of Nine Countries

Home care clients: a research protocol for studying their pathways

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