Concept: Intensity of Home Care Use

Introduction

Several measures were developed to measure the intensity of Home Care use. Because of the extent of the gaps currently in the MSSP data, these measures cannot reliably be produced at this time (see Gaps in the MSSP Service Data discussion below for details). However, they are presented here because some thought has gone into how such variables might be developed, and, in fact, examples of some of these variables are presented in Perspectives on Home Care Data Requirements . These measures could be shown by type of service (e.g. by Home Support Workers, Nursing, etc.). More details on coding for the type of service are available in Service Code Programming Notes available under the SAS Code link below (internal access only) .

1 - Number of service days

The number of service days / total residents is the number of days during the year that clients of the home care program received direct services. If a client received more than one visit during the day, the day is not double counted.

The number of service days / client is the average number of days during the year that direct services were received by clients of the home care program.

2 - Hours of Service (Units)

The service hours / total residents is the total number of hours during the year that direct services were received by clients of the home care program.

The service hours (units) / client is the average number of hours during the year that direct services were received by clients of the home care program.

3 - Hours Per Service Day

The number of service hours per service day is the average number of hours per service day that clients of the home care program received direct services.

Other measures of intensity could include:


• costs of services delivered / year ( per client and per total residents)
  
• costs of services delivered / day of service
  
• costs of services delivered / hour of service.

Gaps in the MSSP Service Data

The process of reviewing and validating the MSSP data for A Look at Home Care in Manitoba uncovered two situations that resulted in gaps in the reporting system and therefore gaps in the service information collected.


1. Gaps Created by Block Care
   
   One of the sources of gaps in the MSSP service data occurs as a result of how the system is currently used. In particular, this refers to the practice of "block care", which occurs, for example, when a single home care worker provides services to people living in a senior citizens housing complex and the worker records the services not according to who received them, but rather consolidated as one data entry. Services recorded under block care cannot be attributed to an individual. Thus, many of the characteristics needed to support analyses of home care use (such as age, gender, region of residence, or whether the individual was hospitalized, entered Personal Care Home or died) cannot be linked to the amount of home care services received. The practice of block care itself is not the problem, rather the problem is that the services that are delivered to many individuals are consolidated as one data entry that cannot be attributed back to the individuals.
   
   Block care is used in a number of RHAs in the province, and can account for large proportions of the units of services delivered. For example, block care accounted for approximately 12% of the direct MSSP units (service hours) delivered in Manitoba in 1998/99 and this rose to 22% in 2000/01. This restricts the ability to use MSSP data to assess the amount of home care services which an individual client receives.
   
   
2. Gaps created by Outside Agencies Non-Reporting
   
   Another cause of the gaps in the home care service data is outside agencies that deliver home care but do not report through the MSSP system (neither directly nor through some equivalent reporting system). This includes services delivered by some of the Rural District Health Centres and therapy services delivered by agencies such as Community Therapy Services and South Central Therapy Services. The MSSP system also does not include purchased attendant services provided for the group-shared arrangements such as the FOKUS project in Winnipeg. Previously, services delivered by the VON were also not captured, but this gap in information should now be closed with the recent (2001) transfer of services formerly provided by the VON to the WRHA. This is a considerable gain in MSSP service information but will not be seen in our data until the 2001/02 data at the earliest.