Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study

Manis, Derek R.; Rahim, Ahmad; Poss, Jeffrey W.; Bielska, Iwona A.; Bronskill, Susan E.; Tarride, Jean‐Éric; Abelson, Julia; Costa, Andrew P.

doi:10.1016/j.jamda.2021.07.002

Cited by 7 publications

(4 citation statements)

References 47 publications

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“…The medical characteristics of residents in terms of dementia and standardized cognitive assessment, activities of daily living, frailty and length of stay were poorly described. Moreover, the type of residential care facilities and services offered may vary from country to country or from institution to institution [ 47 , 48 ]. Finally, socioeconomic characteristics (marital status, income, etc.…”

Section: Discussionmentioning

confidence: 99%

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review

Boucaud-Maitre,

Letenneur,

Dramé

et al. 2023

PLoS ONE

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Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.

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Section: Discussionmentioning

confidence: 99%

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review

Boucaud-Maitre,

Letenneur,

Dramé

et al. 2023

PLoS ONE

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“…We limited our identification of residents in retirement homes in nonunique postal codes to residents at those postal codes who were identified as residing in a retirement home in census-level home care records, given that more than 40% of all residents of retirement homes are recipients of home care. 3 , 9 We defined the index date as when the older adult’s postal code matched to the postal code of a licensed retirement home; we ended follow-up when the older adult transitioned to a long-term care home, complex continuing care facility or died.…”

Section: Methodsmentioning

confidence: 99%

“… 3 , 5 , 6 , 8 Retirement homes are legislated differently from long-term care homes and primarily cater to adults who do not require 24-hour nursing care. 1 , 5 , 9 Unlike long-term care homes, no standardized reporting system is available to identify and describe residents of retirement homes. 10 These residents are conceptualized as having fewer needs for care because they reside in a congregate care home to support independent living; however, this has been difficult to verify given there are no population-level data.…”

mentioning

confidence: 99%

“…Canadian studies have investigated transitions to a long-term care home, risk of hospital admission among those who live with dementia, and life events and health conditions associated with the transition to a congregate care setting. 7 , 9 , 18 – 20 At present, a Canadian population-level cohort of residents of retirement homes that describes the individual-level characteristics and use of health services of the older adults who reside in these homes appears to be lacking. Therefore, it is difficult to position this sector in the gradient of services and housing options for older adults in Canada.…”

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confidence: 99%

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Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study

Manis

Poss

Jones

et al. 2022

CMAJ

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Background: Because there are no standardized reporting systems specific to residents of retirement homes in North America, little is known about the health of this distinct population of older adults. We evaluated rates of health services use by residents of retirement homes relative to those of residents of long-term care homes and other populations of older adults. Methods: We conducted a retrospective cohort study using population health administrative data from 2018 on adults 65 years or older in Ontario. We matched the postal codes of individuals to those of licensed retirement homes to identify residents of retirement homes. Outcomes included rates of hospital-based care and physician visits. Results: We identified 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings. Compared to residents of long-term care homes, residents of retirement homes had significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), alternate level of care (ALC) days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68), but a significantly lower rate of primary care visits (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14). Interpretation: Residents of retirement homes are a distinct population with higher rates of hospital-based care. Our findings can help to inform policy debates about the need for more coordinated primary and supportive health care in privately operated congregate care homes.

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The Inevitability of Reimagining Long-Term Care

Zimmerman

Cesari

Gaugler

et al. 2022

Journal of the American Medical Directors Association

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Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study

Cited by 7 publications

References 47 publications

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review

Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study

The Inevitability of Reimagining Long-Term Care

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