Exploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators

Abstract

As the global population of older people increases, policies aimed at improving health care delivery for older people often include supports for ageing in place. Living in the community not only reduces institutionalisation but also improves quality of life and reduces health care costs. For older people, community rehabilitation offers the opportunity to preserve and maximise function while maintaining the ability to live in the community. However, limited research examines the delivery, coordination and integration of community rehabilitation services in health systems. Our case study explored the perspectives of service providers, managers and health system administrators on the strengths, limitations and gaps in community rehabilitation for older people in one Canadian urban health region. Using interpretive description and thematic analysis, we analysed interview data from: 16 service providers, eight managers and five health system administrators. Three themes were identified: (a) Limited Access to Programs and Services; (b) Need to Emphasise Promoting, Maintaining and Restoring Function; and (c) Lack of Flow Across the System. Participants highlighted that restrictive eligibility criteria limited access to services. Services were organised around health conditions that did not address the needs of older people. Long waitlists meant that services were delayed. Transportation costs limited participation of individuals from lower socioeconomic status (SES). Age restrictions did not reflect differences in the ageing process and the health inequities individuals from lower SES groups experienced. There was a lack of emphasis in community rehabilitation programs on maintaining or restoring function in older people, which is the primary focus of rehabilitation. Furthermore, key stakeholders stressed the need for strengthening the integration of service delivery across the continuum of care. The findings underscore the need to develop a conceptual framework for community rehabilitation to promote greater system integration, access and availability of services and to optimise functional outcomes for older people.

Social care causes of delayed transfer of care (DTOC) from hospital for older people: Unpicking the nuances of ‘provider capacity’ and ‘patient choice’

“…What they do not typically tackle is the nature or capacity of the care system patients are discharged into. Similarly, international commentators have consistently identified a ‘lack of flow’ between acute and community services, but the focus has tended to be on communication and coordination rather than the nature of supply and demand (Dossa et al, 2012 ; Leclair et al, 2021 ; Sheehan et al, 2021 ). Studies identifying issues with homecare provision often neglect to set out precisely what the nature of these problems are (Bragstad et al, 2012 ; Bryan, 2010 ; Hendy et al, 2012 ).…”

Development of a Conceptual Framework for Adult Community Rehabilitation Policy, Planning, Care, and Research: A Multimethod Qualitative Approach

“…Services are administered through fve geographically organized health regions and a provincial health authority. Some publiclyfunded community rehabilitation services may be ofered through outpatient programs (e.g., day hospital and primary care) or through home care programs to select clients [30]. Private rehabilitation services also exist.…”

“…Interviews explored the goals, processes, strengths, and opportunities of existing community rehabilitation services. Full details of data collection are available [30].…”

Unraveling attrition and retention: A qualitative study with rehabilitation professionals

“…While rehabilitation interventions offer many benefits, access can be challenging for those who need them most. In many health care systems, services such as outpatient pediatric rehabilitation services, are limited and hard to access [4,5] while in others, they are unavailable [6,7]. Several factors contribute to these challenges, including an increase in demand for services, partly due to the increasing incidence of chronic diseases and comorbidities, [8,9] shifting demographics and an aging population [10,11].…”