Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-24T03:46:23.972Z Has data issue: false hasContentIssue false
  • English
  • Français

Health Care Services Use in Assisted Living: A Time Series Analysis*

Published online by Cambridge University Press:  23 May 2013

Kimberlyn M. McGrail ,
Meredith B. Lilly ,
Margaret J. McGregor ,
Anne-Marie Broemeling ,
Kia Salomons ,
Sandra Peterson ,
Rachael McKendry  and
Morris L. Barer
Kimberlyn M. McGrail*
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia School of Population and Public Health, University of British Columbia
Meredith B. Lilly
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia
Margaret J. McGregor
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia Department of Family Practice, University of British Columbia
Anne-Marie Broemeling
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia Alberta Health Services
Kia Salomons
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia
Sandra Peterson
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia
Rachael McKendry
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia
Morris L. Barer
Affiliation:
Centre for Health Services and Policy Research, University of British Columbia School of Population and Public Health, University of British Columbia
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Kimberlyn M. McGrail, Ph.D. Centre for Health Services and Policy Research 201-2206 East Mall Vancouver, BC V6T 1Z3 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

This article describes British Columbia’s regulatory model for assisted living and used time series analysis to examine individuals’ use of health care services before and after moving to assisted living. The 4,219 assisted living residents studied were older and predominantly female, with 73 per cent having one or more major chronic conditions. Use of health care services tended to increase before the move to assisted living, drop at the time of the move (most notably for general practitioners, medical specialists, and acute care), and remain low for the 12-month follow-up period. These apparent positive effects are not trivial; the cohort of 1,894 assisted living residents used 18,000 fewer acute care days in the year after, compared to the year before, their move. Future research should address whether and how assisted living affects longer-term pathways of care for older adults and ultimately their function and quality of life.

Résumé

Cet article décrit le modèle réglementaire de la Colombie-Britannique pour l’aide à la vie autonome et était basée sur une analyse des séries chronologiques qui a examiné l’utilisation individuelle des services de soins de santé avant et après leur arrivée en résidence-services. Les 4 219 résidents étudiés dans résidences assistées étaient vieilles et surtout des femmes, 73 pour cent d’entre eux ayant une ou plusieurs principales maladies chroniques. L’utilisation des services de soins de santé a eu la tendance à augmenter avant le passage à la vie autonome, de diminuer au moment du déménagement (notamment pour les médecins généralistes, les médecins spécialistes, et les soins actifs), et de rester faible au cours des 12 mois de la période suivie. Ces effets positifs apparents ne sont pas insignifiantes; la cohorte de 1 894 résidents de la vie assistée utilisaient moins de 18 000 jours de soins actifs dans l’année après, par rapport à l’année précédente, de leur déménagement. La recherche dans l’avenir devrait examiner si et comment aide à la vie autonome affecte à long terme les voies de soins de santé pour les personnes âgées et, finalement, comment leur fonction et la qualité de la vie sont touchés.

Keywords

vieillissmentservices de soins de santéaide à la vie autonome (idée)/résidence-services (résidence)aginghealth care servicesassisted living
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 32 , Issue 2 , June 2013 , pp. 173 - 183
Copyright
Copyright © Canadian Association on Gerontology 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Funding and access to data for this project were provided by the British Columbia Ministry of Health. We are grateful to our colleagues at the Ministry, the Provincial Home and Community Care Council, the Council’s Standing Committee on Assisted Living, and others who provided thoughtful comments on the research as it progressed. Thanks as well to the reviewers whose careful reviews helped to improve the article. Any errors remain the responsibility of the authors.

References

Alzheimer Society of Canada. (2010). Rising tide: The impact of dementia on Canadian society. Toronto: The Alzheimer Society of Canada.Google Scholar
BC Ministry of Health. (2012). Ministry of Health 2012/13 – 2014/15 service plan. Victoria, BC: BC Ministry of Health.Google Scholar
BC Ministry of Health. (n.d.a). Assisted Living Registry. Retrieved 14 April 2011 fromhttp://www.health.gov.bc.ca/assisted/mandate.html.Google Scholar
BC Ministry of Health. (n.d.b). Assisted Living Registrant Handbook. Retrieved 30 April 2012 fromhttp://www.health.gov.bc.ca/assisted/publications.html.Google Scholar
BC Ministry of Health. (n.d.c). BC Home and Community Care Policy Manual. Retrieved 30 April 2012 fromhttp://www.health.gov.bc.ca/hcc/policy-manual.html.Google Scholar
BC Ministry of Health Services, BC Ministry of Health Planning. (2002). Report on Health Authority Performance Agreements 2002/03. Victoria, BC: British Columbia Ministry of Health Services.Google Scholar
Canadian Centre for Elder Law. (2008). Discussion paper on assisted living: Past, present and future legal trends in Canada. Vancouver, BC: British Columbia Law Institute.Google Scholar
Carstairs, S., & Keon, W.J. (2009). Canada’s aging population: Seizing the opportunity. Special Senate Committee on Aging, final report. Ottawa, ON: Government of Canada.Google Scholar
Community Care and Assisted Living Act. (2002). Retrieved 14 April 2011 fromhttp://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/00_02075_01. Victoria, BC: Queen’s Printer.Google Scholar
Community Care and Assisted Living Regulation. (2008). Retrieved 30 April 2012 fromhttp://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/217_2004. Victoria, BC: Queen’s Printer.Google Scholar
Dhalla, I.A., Anderson, G.M., Mamdani, M.M., Bronskill, S.E., Sykora, K., & Rochon, P.A. (2002). Inappropriate prescribing before and after nursing home admission. Journal of the American Geriatrics Society, 50(6), 995–1000.Google Scholar
Fick, D.M., Cooper, J.W., Wade, W.E., Waller, J.L., Maclean, J.R., & Beers, M.H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Archives of Internal Medicine, 163(22), 2716–2724.Google Scholar
Gaugler, J.E., Duval, S., Anderson, K.A., & Kane, R.L. (2007). Predicting nursing home admission in the U.S.: A meta-analysis. BMC Geriatrics, 7, 13.Google Scholar
Lum, J.M., Ruff, S., & Williams, A.P. (2005). When home is community: Community support services and the well-being of seniors in supportive and social housing. Toronto, ON: United Way of Greater Toronto. Retrieved 8 April 2013 fromhttp://www.teamgrant.ca/M-THAC%20Greatest%20Hits/M-THAC%20Projects/All%20info/When%20Home%20is%20Community/Publications/p400534.pdf.Google Scholar
McGrail, K.M., Evans, R.G., Barer, M.L., Kerluke, K.J., & McKendry, R. (2011). Diagnosing senescence: Contributions to physician expenditure increases in British Columbia, 1996/97 to 2005/06. Healthcare Policy, 7(1), 41–54.Google Scholar
Miller, E.A., & Weissert, W.G. (2000). Predicting elderly people’s risk for nursing home placement, hospitalization, functional impairment, and mortality: A synthesis. Medical Care Research and Review, 57(3), 259–297.Google Scholar
Mittelman, M.S., Haley, W.E., Clay, O.J., & Roth, D.L. (2006). Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology, 67(9), 1592–1599.CrossRefGoogle ScholarPubMed
Phillips, C.D., Munoz, Y., Sherman, M., Rose, M., Spector, W., & Hawes, C. (2003). Effects of facility characteristics on departures from assisted living: Results from a national study. The Gerontologist, 43(5), 690–696.CrossRefGoogle ScholarPubMed
Premier’s Council on Aging and Seniors’ Issues. (2006). Aging well in British Columbia. Victoria, BC: Premiers’ Council on Aging and Seniors’ Issues.Google Scholar
Ramroth, H., Specht-Leible, N., & Brenner, H. (2005). Hospitalisations before and after nursing home admission: A retrospective cohort study from Germany. Age and Ageing, 34(3), 291–294.Google Scholar
Reid, R.J., Macwilliam, L., Verhulst, L., Roos, N., Atkinson, M., Care, M., et al. (2008). Performance of the ACG case-mix system in two Canadian provinces. Medical Care, 39(1), 86–99.Google Scholar
Rochon, P.A., Normand, S-L., Gomes, T., Gill, S.S., Anderson, G.M., Melo, M., et al. (2008). Antipsychotic therapy and short-term serious events in older adults with dementia. Archives of Internal Medicine, 168(10), 1090–1096.Google Scholar
Rochon, P.A., Stukel, T.A., Bronskill, S.E., Gomes, T., Sykora, K., Wodchis, W.P., et al. (2007). Variation in nursing home antipsychotic prescribing rates. Archives of Internal Medicine, 167(7), 676–683.Google Scholar
Shadish, W.R., William, R.S., Cook, T.D., & Campbell, D.T. (2001). Experimental and quasi-experimental designs for generalized causal inference. Boston: Wadsworth Publishing.Google Scholar
Stevenson, D.G., Decker, S.L., Dwyer, L.L., Huskamp, H.A., Grabowski, D.C., Metzger, E.D, et al. (2010). Antipsychotic and benzodiazepine use among nursing home residents: Findings from the 2004 National Nursing Home Survey. American Journal of Geriatric Psychiatry, 18(12), 1078–1092.Google Scholar
Wagner, A.K., Soumerai, S.B., Zhang, F., & Ross-Degnan, D. (2002). Segmented regression analysis of interrupted time series studies in medication use research. Journal of Clinical Pharmacy and Therapeutics, 27(4), 299–309.Google Scholar
Wright, B. (2004). An overview of assisted living: 2004. Issue Brief. Washington, D.C.: American Association of Retired Persons Public Policy Institute.Google ScholarPubMed