Home and Community Care Digest

Home and Community Care Digest January 2006 : 0-0

Trends in home care provision from 1991 to 2001: Alberta's experience

Abstract

A provincial home care database was used to assess population-level home care client, service, and provider trends over a ten-year period in Alberta. Key findings were that the numbers of home care clients doubled and average hours of care per client increased, although the duration of care declined. Geographical differences in home care expansion were noted. Because other provinces have experienced similar health care reforms as Alberta over the period of analysis (e.g., hospital downsizing, a shift from inpatient to outpatient care, and regionalization), these trends will likely be of interest to home care decision makers in other jurisdictions.
Background: Using a provincial home care dataset, this study describes population-level home care client, service, and provider changes in Alberta over a ten-year period. Many of the health system reforms in Alberta experienced over the period of analysis (e.g., hospital bed closures, shifting from inpatient to outpatient care and day surgery, and regionalization of health service delivery) have also occurred in other provinces. Thus, the trends reported in this study should be relevant to home care decision makers in other jurisdictions.

Methods: A home care dataset consisting of home care client, services and service provider data from 1991 to 2001 was obtained from Alberta's Ministry of Health and Wellness. The database contained 11,520,251 service event records and 462,877 home care client records. Home care client, service and provider trends were analysed. Service variables included: home care admission date, a classification of need score, type of care received, provider type, hours of direct care received, home care discharge date and reasons, and number of days registered from admission date to death date (if applicable). Indirect or overhead hours were excluded. Demographic variables included: sex, age, birth and death date (if applicable), and postal code (to identify rural or urban residence).

Findings: Considerable home care expansion occurred over the period from 1991 to 2001, both in terms of intensity of care (more care per client) and access to care (more clients). The number of home care clients served annually doubled and province-wide care hours per patient increased by 244%. The duration of care provision (from admission to death date) declined. Care needs were assessed on a classification of need score (ranked 1-7) and were found to have increased from 2.0 to 2.4 over the period. The majority of home care was provided by Home Support Aides (HSAs), while self-managed care increased significantly. Demographically, the majority of home care clients each year were female seniors (aged 65+), although there was a decline in client age and an increase in male clients. Geographically, the proportion of home care clients remained stable in Edmonton and Calgary, but decreased in rural regions. Home care expansion was not uniform across the province: rural areas consistently had the lowest per-client care hours.

Conclusions: This analysis from a 10-year provincial home care database revealed substantial growth in home care clients and care hours. While hospital downsizing seems a plausible stimulus for the observed expansion, the authors note that the predominant utilization of HSAs (as opposed to skilled RNs) to provide care hours may indicate that hospital downsizing was not the primary driver. If expansion was indeed in response to hospital bed closures, one might expect an increase in skilled nursing care hours. These findings suggest that the provision of home care has been shifted to families, though this hypothesis was not examined in this research study. The authors suggest that the high utilization of the least expensive worker may have been an enabling factor in the observed home care expansion. The economic cost of this expansion was not reported.

While this study was conducted in Alberta, it is the first Canadian study to describe population-level home care client, service and provider trends over the past decade - a period in which significant health reforms occurred across the country. These findings may contribute to a more informed discussion of home care in relation to health system reforms, and therefore will likely be of interest to home care decision makers in other provinces.

Reference: Wilson D, Truman CD, Huang J, Sheps S, Thomas R, Noseworthy T. "The possibilities and the realities of home care." Canadian Journal of Public Health, 2005; 96(5), 385-389.

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