1 in 9 new LTC admissions could be kept at home

OTTAWA – Many older adults in Canada wish to remain at home for as long as possible as they age. However, some individuals with mild or moderate health conditions or physical limitations are admitted to long-term care even though they potentially could have been cared for at home with the proper supports.

An analysis by CIHI measured the percentage of people newly admitted to long-term care who had similar health characteristics as those living at home with formal supports. We found that in 2018 – 2019, about 1 in 9 newly admitted residents in long-term care homes potentially could have been cared for at home. This represents more than 5,000 long-term care spaces in reporting provinces and territories.

“Staying at home for as long as possible can offer a better experience for many people, and can help ensure that long-term care beds are reserved for those with complex needs who require full-time care,” said Mélanie Josée Davidson (pictured), director, health system performance. “This data can help identify where there are gaps in services and contribute to meaningful changes that improve the healthcare experiences of patients and families.”

Residents and family members of residents admitted to long-term care say they experienced various barriers to remaining at home:

• Difficulty navigating the healthcare system – People experienced confusion and challenges around who to contact, what services were available, the amount of time required to coordinate services and the lack of continuity across the system.
• Financial barriers – Because publicly funded home care does not cover all costs associated with caring for someone at home, some families experienced significant out-of-pocket expenses. Those living in rural and remote communities faced higher travel costs for medical appointments and limited availability of home care services and supports.
• Responsiveness – People emphasized the importance of reliable home care staff, as well as the need for services that were flexible to the changing needs of the person receiving care.
• Access to special services – People highlighted the need for social and emotional support, help with non-medical needs and services tailored to their language and cultural needs.

People living in rural areas were over 50% more likely than those in urban areas to be admitted to long-term care when they potentially could have been cared for at home. This may be due to fewer home care services being offered in rural and remote areas.

Despite having lighter care needs, people living alone were twice as likely as those living with family members to be admitted to long-term care.

In Canada, more women are admitted to long-term care since, on average, women live longer than men. Because of this, they are more likely to live alone and less likely to have an unpaid caregiver who can provide support when needed, which can lead to early admission to long-term care.

Our new analysis shows that more than 1 in 3 unpaid caregivers of individuals who receive home care in reporting provinces and territories experience distress – which can include feelings of anger or depression, or the inability to continue with caring activities.

Unpaid caregivers play a vital role in our health systems by supporting people with health challenges to stay at home or in the community. Providing care to a family member or friend can be demanding, with profound emotional, mental, financial and physical impacts.

High rates of caregiver distress may signal a need for more effective and appropriate home care services and community supports.

“By improving home care services and community supports, caregivers could be better equipped to provide the proper care for those who wish to stay at home, and be less likely to be distressed,” said Tracy Johnson, director, health system analysis and emerging issues. “Those resources could include more hours of formal home care, better access to meal delivery services, respite care or help navigating the healthcare system.”

Caregivers who are distressed spend an average of 38 hours a week providing care – the equivalent of a full-time job. This is twice the number of caregiving hours provided by caregivers who are not distressed.

Caregiver distress rates are higher among those who support people requiring greater assistance with personal care such as bathing, dressing and personal hygiene.

They are also twice as likely to be distressed if they care for a person with communication difficulties or behavioural problems.

Caregivers who live with the person receiving home care are twice as likely to be distressed as those who do not. Among those who live together, about half are spouses and a third are adult children caring for their parents.