We draw on our research, our lived experiences of disability and the grounded expertise of disabled persons living in long-term care (LTC) homes as co-researchers, to illustrate the value of disability-led participatory research. Our approach to a co-designed collaborative project on young adults living in LTC highlights the benefits of research that centers the lived realities of disabled people. Points of interest• Research and knowledge about disabled people living in long-term care (LTC) homes routinely excludes the perspectives of the people who live there; this is especially true for younger residents living in LTC. • This article shares information about a study on promising approaches to residential LTC for people under 65 years of age that was co-led with care home resident researchers. • The study design provided opportunities and supports to encourage meaningful engagement, such as training and access to research assistants. • Resident co-researchers brought lived expertise and experiential insights that enriched the research process and knowledge produced, and that supported them in their own disability advocacy work. • Inequities persist when budgets fail to consider and address barriers to residents' full participation in all aspects of the research.

Transitional care programs are effective for improving patient outcomes upon discharge from acute care services and reducing the burden of healthcare costs; however, little is known about the types of transitional care programs for older adults across Canada. This exploratory study gathered an in-depth understanding of Canadian transitional care programs and described how each program functions to support older adults and family/friend caregivers. Nine key informants were interviewed about the development of transitional care programs within four Canadian provincial regions including Atlantic, Central, Prairie, and West Coast. Key facilitators and barriers influencing the development and long-term success of transitional care programs included program scope, program structure, continuity of care, funding, and health system infrastructure. Future research is required to identify how a broad range of transitional care programs operate and to disseminate knowledge with health leaders and decision-makers to ensure transitional care programs are embedded as essential health system services.

Background An increasing proportion of older adults experience avoidable hospitalizations, and some are potentially entering long-term care homes earlier and often unnecessarily. Older adults often lack adequate support to transition from hospital to home, without access to appropriate health services when they are needed in the community and resources to live safely at home. Purpose This study collaborated with an existing enhanced home care program called Home Again in Nova Scotia, to identify factors that contribute to older adult patients being assessed as requiring long-term care when they could potentially return home with enhanced supports. Methods Using a case study design, this study examined in-depth experiences of multiple stakeholders, from December 2019 to February 2020, through analysis of nine interviews for three focal patient cases including older adult patients, their family or friend caregivers, and healthcare professionals. Results Findings indicate home care services for older adults are being sought too late, after hospital readmission, or a rapid decline in health status when family caregivers are already experiencing caregiver burnout. Limitations in home care services led to barriers preventing family caregivers from continuing to care for older adults at home. Conclusions This study contributes knowledge about gaps within home care and transitional care services, highlighting the importance of investing in additional home care services for rehabilitation and prevention of rapidly deteriorating health.

Background: An increasing proportion of older adults experience avoidable hospitalizations, and some are potentially entering long-term care homes earlier and often unnecessarily. Within Canada, approximately 10 percent of newly admitted long-term care residents could have potentially been cared for at home. Without adequate support from health care services to transition older adults from hospital to home, they often lack access to appropriate services when they are needed in the community thus making them more vulnerable to avoidable hospital visits, rapid deterioration of health, and earlier and unnecessary placement into residential long-term care. The purpose of this study was to collaborate with an existing enhanced home care program called Home Again in Halifax, Nova Scotia, to identify factors that contribute to older adult patients being assessed as requiring long-term care when they could potentially return home with enhanced supports. Methods: Through a retrospective case study design, we analyzed nine interviews for three focal patient cases including older adult patients, their family or friend caregivers, and healthcare professionals. Results: Findings indicate home care services for older adults are being sought too late, after hospital re-admission, or a rapid decline in health status when family caregivers are already experiencing caregiver burnout. Limitations in home care services ultimately led to barriers preventing family caregivers from continuing to care for older adults at home, such as absence of overnight services, a lack of information about home care services, and a lack of knowledge to navigate resources available. Conclusion: This study contributes knowledge about gaps within home care and transitional care services, highlighting the significance of investing in additional home care services for rehabilitation and the prevention of rapidly deteriorating health when older adults are discharged home after their first hospital visit. By understanding experiences and challenges of patients, family or friend caregivers, and healthcare professionals, we identified ways to reduce healthcare costs and improve the delivery and quality of home care services to better support older adult patients and their family or friend caregivers and to ensure hospitalized older adults are not unnecessarily admitted to nursing homes.

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Objective: The objective of this systematic review is to identify what transitional care programs exist across Canada, including the characteristics and outcomes of these programs. Introduction: There is growing evidence of the benefits of transitional care programs to support older adults moving from hospital to home. However, there is limited literature identifying the types of transitional care programs that exist internationally and little evidence available within Canada. Inclusion criteria: Sources of gray literature published from 2016 that focus on older adults receiving services from transitional care programs to move from hospital to home in Canada will be considered for inclusion. Sources of gray literature will be excluded if interventions are targeted at adults younger than 65 years, Indigenous adults younger than 55 years, or if the primary discharge destination is not an independent community dwelling. Interventions designed for older adults waiting in hospital for long-term care placement will also be excluded from this review. Methods: An initial limited search of Canadian national gray literature resources will be undertaken, followed by an advanced Google search of Canadian resources and news media reports. Lastly, an advanced search of Google for all 10 provinces and 3 territories will be undertaken to target examples of local transitional care programs that may not be found through a national search, such as local pilot projects, health region–specific programs, and provincial organizations. All identified sources will be retrieved and full text review of selected citations assessed in detail by 2 independent reviewers. Data about the characteristics and outcomes of transitional care programs and results will be extracted and synthesized, with a meta-aggregation approach for grading according to JBI ConQual method. Systematic review registration number: PROSPERO CRD42022298821

Background Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011–2017. We accessed variables from the RAI–MDS 2.0 to assess the association of the dependent variable “fall within the last 31–180 days” with multiple independent factors, using generalized estimating equation models. Results A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.

It is often during transitions between health services that many issues arise for older adults, such as care that is poorly coordinated, additional burden placed on family and friend caregivers, and inappropriate placement in nursing homes. The Home Again program delivered by the provincial health authority in Nova Scotia, Canada, provides transitional care through providing additional support beyond what is normally provided through home care services to help older adults transition home after a hospital admission. The purpose of this research was to identify what factors contribute to older adults being placed unnecessarily in a nursing home when they could receive care through the Home Again program. Through using a retrospective multiple case study design, we analyzed interviews for five cases including older adult patients, their family or friend caregivers, and healthcare professionals in each case. Results indicate all hospitalized patients experienced a major health event or rapidly declining health. All family and friend caregivers experienced burnout and frustration from the lack of sufficient home care supports and quality of services available, such as services provided throughout the night. Healthcare professionals discussed that patients were placed on a waiting list for nursing homes due to lack of home care supports and resources for caregivers. This study contributes to our knowledge about better processes to ensure that hospitalized older adults are not unnecessarily admitted to nursing homes which can result in reduced healthcare costs and improved delivery and quality of care to older adults and their family and friend caregivers.