Concept: Home Care and Personal Care Homes (PCH)

Introduction

One of the objectives of Manitoba's Continuing Care Program is to assess and place persons in a long-term care bed if they can no longer be maintained at home safely or economically with home care services, and to provide them with services at home until they are placed. Thus, the home care report looked at the duration of support that individuals were given before entering a personal care home (PCH). The report examined the use of home care before an individual entered a PCH, before paneling for PCH placement and between the time of paneling and admission to a facility.

Identification of home care clients who enter PCH

In a specific year, individuals who enter a PCH can be identified using the PCH files - identified in the PCH files as levelpad = 1, 2, 3, or 4. (Levels 1-4 are PCH levels, level 5 is respite, level 6 are chronic care residents (Deer Lodge, Riverview, some rural hospitals), level 7 is chronic care respite, level 8 is hospital patient awaiting placement to PCH, and level 9 is hospital patient awaiting placement to chronic care facility). Variables containing the date of admission to PCH and level of admission are in the Home Care data so that linkage to the PCH files is not needed if you are using that data set.

For the deliverable, if an individual was registered with home care during the specified year and entered a PCH anytime during that year, then they were included in the analysis of home care before PCH. Inclusion was not limited to individuals who entered PCH within a specified time period (e.g. 30 days) from the date of home care termination.

Calculation of home care days before PCH entry

For individuals who were registered with home care during the specified year and entered a PCH anytime during that year, the number of days they were registered with home care during the 365 prior to PCH admission and since a specified date (April 1, 1996 for the deliverable) were calculated. This was done by looking at duration registered with home care for all episodes of home care prior to PCH admission, not just that last episode prior to admission. The date of April 1, 1996 was somewhat an arbitrary choice - for individuals entering PCH in 1998/99, we were looking back for 2-3 year from when they were admitted. It is also possible to determine e.g. home care days in the 3 years prior to PCH admission, and in many respects I think that may be easier to understand (i.e., for everyone we would look back exactly 3 years from their date of entry to PCH).

Calculation of home care days before/after PCH paneling

To determine if an individual needs to enter a PCH, a panel of experts assesses the individual. If the panel determines that the individual needs to enter a PCH, then the date on which that decision was made is called the paneling date.

For these analyses we considered the PCH paneling date to be the earliest date on which an assessment yielded a paneling date for levels 1 to 4 or 8 (Levels 1-4 are PCH levels, level 8 is hospital patient awaiting placement to PCH). Variables containing the paneling date and the level of paneling are in the Home Care data so that linkage to the PCH files is not needed when using that data set.

To determine the duration of support provided before and after the date on which the decision to panel an individual was reached, the calculation of the days before PCH entry in the past year or since a specified date were divided into days before and days after the paneling date.

Calculation of total days and days in hospital after PCH paneling

As well as determining the number of days registered with home care between PCH paneling and entry to PCH since April 1, 1996, we also looked at the total number of days that occurred between PCH paneling and entry to PCH since April 1, 1996 ¹ . If the individual were registered continuously in home care from the panel date to PCH entry, then this would be equal to the home care days after PCH paneling found above.

The number of days spent in hospital between PCH paneling and PCH admission (since April 1, 1996) was also found. This involved summing the number of inpatient hospital days for these individuals between PCH paneling and PCH admission, since April 1, 1996 (being careful not to double count hospital days. Nursing stations and out-of-province hospitals were excluded).

Footnote:

¹ - For figure 7.4 of the report, all days between PCH paneling and PCH entry were counted, even if the paneling date was prior to April 1, 1996. In the sample program these days are cut off at April 1, 1996 to be consistent with the home care days and hospital days in that figure.