Patterns and predictors of home care utilization in Eastern Canada: Analyzing changes over a 5-year period (1996 - 2001)

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Hawkins, Glenda
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Mount Saint Vincent University
Research on home care is relevant and important to the health of Canadians. Home care provides services that allow individuals to remain within their own homes for as long as possible by maintaining their physical, mental, social, and emotional wellbeing, preventing the deterioration of health and the need for institutionalization and substituting acute care services provided within hospitals. Given the relative value and priority being placed on home care programs to meet cost-effective demands, it is important to understand home care usage. The goal of this research project was to analyze trends in the utilization and composition of government-supported home care services in Eastern Canada in 1996 and in 2001 using a behavioral model developed by Andersen (1968). Secondary data from the 1996/97 National Population Health Survey and the 2000/01 Canadian Community Health Survey were analyzed to address four main research questions: (a) What are the socio-demographic and health characteristics of home care users in 1996 and in 2001, and has that profile changed over time; (b) Has the proportion of users for each type of service received (including nursing, other health care, personal care, homemaking, and respite) changed between 1996 and 2001; (c) Has the pattern of usage (e.g., the number of different types of services an individual received) changed between 1996 and 2001; and (d) What are the predictors of home care utilization in 1996 and in 2001 and have they changed over time? Results revealed that over time home care user characteristics associated with nursing service use (i.e., younger age, higher income, recently hospitalized) have become more dominant. These changes correspond to a substantial increase in the proportion of home care users receiving nursing services and a simultaneous decline in the proportion receiving homemaking services over the same time period. These findings which support Andersen’s model, suggest that essential components to predict home care service usage in Eastern Canada should include need factors (needing assistance with activities of daily living and instrumental activities of daily living and hospitalization), which were the greatest predictors of home care use, followed by predisposing (age), and enabling factors (income). These results can be explained by the current political context in which the need to provide cost-effective services has resulted in the prioritization of short-term acute care services, often at the expense of long-term chronic care services. As this trend continues, in combination with population aging and the limited availability of caregivers, the demand for home care services could be exponential. Decision makers within government must act to ensure that the care needs of all clients, acute or chronic, are met and that the initial foundation on which home care programs were built be maintained and strengthened.
Home care , Eastern Canada , Hospitals , Cost-effective demands