Examining Variation in Access to Long-term Home Care Services for Ontario Seniors

Background: As Canadaâ s population ages, a greater number of seniors will require formal and informal care to remain in their homes. To effectively maintain seniors in their homes, equitable access to home care services is required. However, variations in access to these services have persisted in Ontario for decades. Purpose: The purpose of this study was to examine factors affecting access to long-term home care for seniors identified as at moderate risk of adverse outcomes and to determine whether variation in access to these services exists across Ontario. Methods: Administrative data were used to conduct a secondary analysis. A non-experimental design was employed. Factors associated with three dimensions of access to home care (propensity, intensity, wait time) were examined across four outcome categories: no home-based care, home-based nursing services alone, home-based supportive care services alone, and home-based nursing and supportive care services together. Results: Personal characteristics, caregiver characteristics and regional characteristics were found to affect all dimensions of access. Factors associated with propensity to receive services varied across outcome categories and included having a dementia diagnosis, dependence in performing activities of daily living, having a previous fall, previous health care utilization, and the region in which the patient resides. Similarly, factors associated with intensity of services were dependent on type of care received and included education, continence and living with a caregiver for nursing services and cognitive status, functional status, health status, and living with a caregiver for supportive care services. While, intensity of nursing services did not vary across regions, intensity of supportive care services was significantly different across the province. Factors affecting wait times included sex, functional status, health status, and receiving nursing care. Conclusions: Inequity in access to home care services persists across Ontario. Variation in propensity to receive services, intensity of supportive care services received, and wait times was evident across regions. Inequitable access to services could result in negative outcomes for those unable to access services. Equitable access to home-based care is vital to ensuring Ontario seniors are able to live and receive care in their preferred location, which for most seniors is at home.Ph.D