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Indicator Metadata

Name

New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home

Short/Other Names

Not applicable

Description

The percentage of newly admitted long-term care residents who have a clinical profile similar to the profile of clients cared for at home with formal supports in place.

Examples of formal home care supports include help with daily tasks such as bathing, dressing, eating and/or toileting.

Interpretation

A low percentage is desirable for this indicator.

A higher percentage indicates a larger number of newly admitted long-term care residents who potentially could have been cared for at home with formal supports in place.

This indicator can help to

  • Show when additional home supports could potentially delay or prevent early admission to long-term care;
  • Demonstrate the importance of effective placement policies and services across the health care continuum; and
  • Provide support for initiatives that help residents remain in their homes for as long as possible.
HSP Framework Dimension Health System Outputs: Access to comprehensive, high-quality health services
Areas of Need Living With Illness, Disability or Reduced Function
Geographic Coverage Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon
Reporting Level/Disaggregation National, Province/Territory
Indicator Results https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en
Identifying Information
Name New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home
Short/Other Names Not applicable
Indicator Description and Calculation
Description The percentage of newly admitted long-term care residents who have a clinical profile similar to the profile of clients cared for at home with formal supports in place.

Examples of formal home care supports include help with daily tasks such as bathing, dressing, eating and/or toileting.

Calculation: Description

Unadjusted rate:

(Total number of newly admitted residents in a long-term care facility with a completed Resident Assessment Instrument–Minimum Data Set 2.0 [RAI-MDS 2.0] or interRAI Long-Term Care Facilities [LTCF] assessment that details clinical characteristics similar to those of home care clients who are living well in the community with formal supports) ÷ (Total number of newly admitted residents with a completed assessment in a given fiscal year) × 100

For more information, please see New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home: Appendices.

Calculation: Geographic Assignment

Place of residence or service

Calculation: Type of Measurement

Percentage or proportion

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
Adjusted rate:

The following covariates are used in risk adjustment:

  • Individual covariates: age group, sex, schizophrenia diagnosis, bipolar disorder diagnosis, and whether a resident lived alone prior to admission to a long-term care facility.
Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
Total number of newly admitted long-term care residents with completed RAI-MDS 2.0 © or interRAI LTCF © assessments in a given fiscal year.

Inclusions:

  1. Assessments completed in a long-term care facility (SECTOR_CODE = 4 for provinces/territories submitting to the Continuing Care Reporting System [CCRS])

  2. Sex coded as male or female
  3. First assessment completed in a fiscal year for residents who had not been assessed in the last 5 years with a RAI-MDS 2.0 or interRAI LTCF assessment
  4. Province/territory code available

Exclusions:

  1. Assessments done in the hospital-based continuing care sector (for provinces/territories submitting to CCRS)
  2. Residents missing any assessments for numerator definition (i.e., Cognitive Performance Scale, ADL (Activities of Daily Living) Self-Performance Hierarchy Scale, falls, verbal or physical abuse, wandering)
  3. Residents without valid age recorded, schizophrenia diagnosis, bipolar disorder diagnosis, and living situation prior to admission (these covariates are used in risk adjustment)
  4. Residents admitted for a short length of stay:
    1. Discharge projected within 90 days (Q1C_STAY_SHORT_DURATION = 1 or 2 for RAI-MDS 2.0 or Q2 = 0, 1, 2 or 3 for interRAI LTCF) and
    2. Length of stay at discharge for the resident (DISCHARGE_LOS_DAYS ≤120 days)
  5. Residents receiving care in facilities that did not submit to CCRS or to the Integrated interRAI Reporting System (IRRS) in Q4 (January 1 to March 31) of the previous fiscal year
Numerator

Description:
Total number of newly admitted long-term care residents (incident cases) with a completed RAI-MDS 2.0 or interRAI LTCF assessment that details clinical characteristics similar to those of home care clients who are living well in the community with formal supports, defined by the following inclusions.

Inclusions:

  1. Long-term care residents with a completed assessment that details the following combination of characteristics:
    1. Cognitive Performance Scale = 0, 1 or 2
    2. ADL Hierarchy Scale = 0, 1 or 2
    3. No falls in the past 30 days
    4. Not physically abusive in the past 7 days (RAI-MDS 2.0) or 3 days (interRAI LTCF)*
    5. Not verbally abusive in the past 7 days (RAI-MDS 2.0) or 3 days (interRAI LTCF)*
    6. Did not wander in the past 7 days (RAI-MDS 2.0) or 3 days (interRAI LTCF)*

* The Assessment Reference Date (ARD) is the end of the observation period for items on the RAI-MDS 2.0 or interRAI LTCF assessment. The look-back period for most RAI-MDS 2.0 items is 7 days. The look-back period for most interRAI LTCF items is 3 days.

For more information, please see New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home: Appendices.

Background, Interpretation and Benchmarks
Rationale

Delaying or preventing admission to a long-term care facility for persons whose needs could potentially be met through home care programs may help to

  • Provide better experiences for clients, by supporting the desire of most seniors to remain at home for as long as possible; and
  • Ensure that long-term care facilities have the capacity to provide care for residents with more complex health needs.
Interpretation A low percentage is desirable for this indicator.

A higher percentage indicates a larger number of newly admitted long-term care residents who potentially could have been cared for at home with formal supports in place.

This indicator can help to

  • Show when additional home supports could potentially delay or prevent early admission to long-term care;
  • Demonstrate the importance of effective placement policies and services across the health care continuum; and
  • Provide support for initiatives that help residents remain in their homes for as long as possible.
HSP Framework Dimension Health System Outputs: Access to comprehensive, high-quality health services
Areas of Need Living With Illness, Disability or Reduced Function
Targets/Benchmarks Not applicable
References
  1. British Columbia Ministry of Health, Canadian Institute for Health Information. Modelling Impact Changes to the Community Care and Assisted Living Act in British Columbia. 2018.
  2. Canadian Institute for Health Information. Seniors in Transition: Exploring Pathways Across the Care Continuum. 2017.
  3. Gruneir A, Forrester J, Camacho X, et al. Gender differences in home care clients and admission to long-term care in Ontario, Canada: A population-based retrospective cohort study. BMC Geriatrics. 2013.
  4. Gaugler J, Yu F, Krichbaum K, et al. Predictors of nursing home admission for persons with dementia. Medical Care. 2009.
  5. Jutan NM. Integrating supportive housing into the continuum of care in Ontario. UWSpace. August 2010.
  6. Luppa M, Luck T, Weyerer S, et al. Prediction of institutionalization in the elderly. A systematic review. Age and Ageing. 2010.
  7. Office of the Seniors Advocate British Columbia. Home Support: We Can Do Better. 2019.
Availability of Data Sources and Results
Data Sources

CCRS, IRRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2018
Last Available Year:
2019

Geographic Coverage

Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon

Reporting Level/Disaggregation

National, Province/Territory

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Brief
URL: https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en

Updates

Not applicable

Quality Statement
Caveats and Limitations

This indicator is a starting point to measure the percentage of newly admitted long-term care residents who potentially could have been cared for at home with formal supports in place and can be further refined as data collection across provinces/territories improves.

  • Provinces and territories offer different levels of publicly funded services outside of long-term care; this indicator focuses on persons who could live well at home with access to formal home care supports.
  • This indicator considers only newly admitted long-term care residents; other long-term care residents could also potentially be supported outside the long-term care setting if other forms of supports were accessible to them (e.g., assisted or supportive living).
  • The response sets and look-back periods for the assessment items used to identify residents who potentially could have been cared for at home differ between the RAI-MDS 2.0 and interRAI LTCF assessments.
  • This indicator data is not linked, which means we are unable to trace the care pathway of newly admitted long-term care residents (e.g., from hospital or community) to understand their needs prior to admission to long-term care.
  • This indicator includes data submitted by publicly funded long-term care facilities and excludes private long-term care, assisted or supportive living, and retirement homes.
Trending Issues

Not applicable

Comments

This indicator belongs to the Shared Health Priorities portfolio measuring access to mental health and addictions services and to home and community care.

More information on this indicator is available in the 2020 companion report on the Shared Health Priorities page.

RAI-MDS 2.0 © interRAI Corporation, Washington, D.C., 1995, 1997, 1999. Modified with permission for Canadian use under licence to the Canadian Institute for Health Information.

RAI-HC © interRAI Corporation, Washington, D.C., 1994, 1996, 1997, 1999, 2001. Modified with permission for Canadian use under licence to the Canadian Institute for Health Information.

interRAI LTCF © interRAI Corporation, Washington, D.C., 1990–2011. Modified with permission for Canadian use under licence to the Canadian Institute for Health Information.