Home and Community Care Digest

Home and Community Care Digest March 2005 : 0-0

The impact of hospital restructuring on home care nursing


In 1996, the Health Services Restructuring Commission initiated a restructure in the health care delivery. It was expected that the decrease in bed capacity in hospitals would increase the home care provision province-wide. Patient data from both the local hospitals and CCAC were examined. This research examined the effect of Ontario's recent health reforms on home care nursing in Kingston. The results revealed overall demand for home care nursing increased after the hospital restructure.
Background: Modern health reform includes a shift from institutional to home-based care. In Ontario, it was expected that following the restructuring program initiated by the Health Services Restructuring Commission (HSRC), home care would become more prominent in the delivery of services because of anticipated decrease in hospital bed capacity. One study predicted there would be a 20% expansion in home care delivery across the province due to the health system restructuring, while the HSRC forecasted a province-wide increase of 55% by 2003. The purpose of this research was to measure change (a) in the number and rate of home care nursing clients admitted from hospitals and (b) in the volume and intensity of home care nursing services.

Methods: The study aimed to identify trends in the use of home care nursing through a retrospective analysis. Linked hospitalization and local home-care utilization data for 1996 and 2000 were employed. Hospital discharge data were obtained from the Kingston General and Hôtel Dieu hospitals, which brought together local data from the Discharge Abstracts Database managed by the Canadian Institute for Health Information (CIHI). Home-care utilization data were obtained from the Kingston, Frontenac, Lennox and Addington CCAC. Eligible participants met the following criteria: 1) greater than 45 years old, 2) discharged to a home setting from Kingston General or Hôtel Dieu hospitals between 1996 and 2000, 3) covered by OHIP, and 4) had been admitted to the local CCAC within five days before and after hospital discharge for care by a registered nurse (RN) or registered practical nurse (RPN).

Findings: The hospitalizations and home care client numbers decreased between 1996 and 1998 and increased during 2000. In addition, the age-gender standardized rates of home care increased by 10% between 1996 and 1997. By 2000, the rate of home care use rose by 4%. Overall, the study indicates that the average home care client received more nursing services since the implementation of the new hospital structure. The study also measured service intensity at various time intervals after the hospital discharge. In 1999, the number of mean visits per client was the highest for all time intervals. The highest volume of nurse and practical nurse visits occurred in 2000. In addition, the registered nurses made twice as many home care visits as did the registered practical nurses for the time intervals. Finally, the total visits and visits per client increased between 1996 and 1999.

Conclusions: The adoption of the new hospital structure resulted in the average home-care client receiving more nursing services. However, results should be interpreted with some caution. The quality of data on the information gathered from home care agencies was not verified. Furthermore, some eligible patients may have been omitted from the study due to errors in their birth dates or health care card numbers. Lastly, some patients were home care clients prior to hospital admission. The study was also unable to control for other external factors that may have affected home care delivery, such as changes in budgets and in hospital or CCAC policies. For example, it was expected that a certain percentage of the hospital budget would be transferred to home care as result of the hospital beds closing. When this transfer did not occur, the volume of service for the CCACs may have been impacted. In other words, the CCACs may have lacked funds to handle increased requests from the community. Regardless of whether clients are in hospitals or in the home, RNs and RPNs will be delivering the care. Therefore demand for nursing services will continue to grow in community care after HSRC health reform.

Reference: Keller S., Hunter D., and Shortt S.E.D.. "The Impact of Hospital Restructuring on Home Care Nursing". Canadian Journal of Nursing Leadership, 2004; 17, 82-89.


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