Many nursing home residents could stay at home: CIHI

OTTAWA – A study by the Canadian Institute for Health Information (CIHI) has found that up to 30 percent of seniors entering residential care could be supported in home care, given the right mix of community services and in-home care.

The study, “Seniors in Transition: Exploring Pathways Across the Care Continuum,” determined that one in five (22%) seniors who entered residential care following an initial assessment had low to moderate MAPLe scores and might have been able to be supported in home care.

Moreover, CIHI identified additional subpopulations of seniors for whom appropriate community-based supports could have helped delay or avoid admission to residential care. “When we include these subpopulations, the ratio increases to about 1 in 3 (30%),” the study said.

The Method for Assigning Priority Levels (MAPLe) is a tool used by healthcare professionals to prioritize clients’ needs and to appropriately allocate home care resources and placement in long-term care facilities. Low Clients are generally independent, without physical disabilities, and with only minor cognitive loss. There are no problems with behaviour, the home environment, medication, or skin ulcers. Some limited home care support may be needed because of early losses of function in limited areas.

Mild Clients need only a light level of care due to some problems with instrumental activities of daily living (e.g., housework, transportation) or loss of physical stamina.

Seniors in Transition: Exploring Pathways Across the Care Continuum studied more than 59,000 seniors in 35 health regions over a three-year period whose care needs were assessed by healthcare professionals.

“Over the next 20 years, the seniors population is expected to grow at an unprecedented rate,” said Georgina MacDonald (pictured), vice president, Western Canada, Canadian Institute for Health Information.

“To improve the sustainability of long-term care in Canada and support seniors who want to remain in the community as long and as independently as possible, we need to better understand how resources are currently used. The numbers show that we can do more to ensure our seniors get the care that best matches their needs.”

According to the CIHI report, “Factors that influence admission to residential care included the need for physical assistance, cognitive impairment, wandering, living alone and having a caregiver who is unable to continue providing care. Demand for residential care might be offset by developing or expanding home care services to address these factors, and by further integrating the hospital and continuing care sectors.”

Seniors who received their initial assessment in hospital were significantly more likely to be admitted to residential care than seniors who received an initial assessment in the community.

Policies and practices intended to facilitate a timely discharge from hospital may have the unintended consequence of an early admission to residential care. Continued integration and alignment between hospital and continuing care policies and practices may help ensure that seniors are able to remain in the community longer.

Alternate level of care (ALC) lengths of stay in hospital were longer for seniors awaiting return to the community than for those awaiting placement in residential care. While those that went on to residential care were more likely to experience ALC days, their stay in ALC was markedly shorter than those who returned to the community.

Policies and programs that aim to better coordinate care among different agencies and informal caregivers, within home care services, and between acute and continuing care systems should be considered as important factors in reducing patients’ stay in ALC.

“This study provides information to support decision-making about continuing care services for seniors. Opportunities to delay or avoid reliance on residential care not only ensure that seniors can spend more time in the community, but also help ensure that health resources go where they are most needed. Using existing resources effectively and efficiently – without compromising care quality, timeliness and outcomes – is what health organizations across the country are striving for.”

Growth in Canada’s seniors population has been steady for the past 20 years. Within the next 20 years, however, the population of older seniors (those age 75 and older) – who rely more heavily on continuing care services – is expected to double, from 2.6 million to 5.7 million.

To help people understand the populations served by home care and residential care in selected health regions, CIHI developed an interactive online tool that allows users to observe characteristics of seniors populations over time and across care settings, at the health region level.

This new report supports CIHI’s commitment to help stakeholders better understand Canada’s seniors population, as outlined in CIHI’s strategic plan. CIHI is focusing its efforts on influencing and improving Canada’s health systems, guided by key themes and key populations that our stakeholders told us were important.

About CIHI

The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada’s health systems and the health of Canadians. We provide comparable and actionable data and information that are used to accelerate improvements in healthcare, health system performance and population health across Canada. Our stakeholders use our broad range of health system databases, measurements and standards, together with our evidence-based reports and analyses, in their decision-making processes. We protect the privacy of Canadians by ensuring the confidentiality and integrity of the healthcare information we provide.