Concept: Long Term Care (LTC) Data Overview

Introduction

This concept provides information about the Long Term Care (LTC) data held in the Manitoba Population Research Data Repository. The concept introduces some LTC terminology and provides brief definitions for these terms. It provides detailed information about the two LTC data sources in the Manitoba Population Research Data Repository, including a list of files, what the files contain, including some of the important variables in these files, and what the file can be used for. Additional information identifies some of the data limitations and cautions to be aware of when using the data. Example SAS code for working with the data is also provided (Internal Access Only).

The two LTC data sources in the Repository include:


• Manitoba Health LTC Utilization database
  
• Winnipeg Regional Health Authority (WRHA) LTC Minimum Data Set (MDS) database

Long Term Care Terminology and Definitions

The following section lists some common LTC terminology and provides a brief definition for each term.

• Long Term Care (LTC) includes data related to any chronic and rehabilitative services provided by any long term care facilities, such as Personal Care Homes (PCH), chronic care (CC) facilities and long term care beds in acute care hospitals.
  
  
• Personal Care Homes (PCHs) are licensed residential facilities for predominantly older persons with chronic illness or disability. The LTC term is more inclusive than the PCH term. PCHs are the largest part of the more general long term care (LTC) concept.

  NOTE: Before beginning your work with the data, it is recommended that you identify what facilities and level of care will be included in your study definition of LTC / PCH.

• Residents are people who are currently residing in LTC / PCH facilities at a certain point in time, during the specified study period, or annually. People waiting for LTC / PCH placement in acute care facilities are usually counted as LTC residents.
  
  
• Admission to LTC services can be defined in different ways, including:
  
  
  • admission into licensed PCH only;
    
  • admission to a PCH bed within any facility with such beds; or
    
  • admission into any type of LTC facility (such as PCH, PCH bed in hospital, or CC facility).
  
  For more detailed information about admissions to PCH, please read the New Admission into Personal Care Homes (PCHs) concept.
  
  
• Panel to PCH - Paneling is the approval process for eligibility for LTC, including admission to a PCH. The Panel Review Board includes physicians and staff from the Long Term Care Access Centre and Home Care. Their role is to review the application information to ensure the most appropriate care option. If the Panel determines the individual does not require a PCH placement, at that time there will be no assessment record in the LTC database. The Panel record could be missing for a certain period of time for some people who were approved for PCH placement but instead opted to go into Supportive Housing (SH). Date and Level of Care at Panel can be determined from the individual's first assessment record in the LTC database.
  
  
• Waiting Time - is the time from the date of Panel to the date of first LTC / PCH admission.
  
  
• Length of Stay (LOS) - is the time from the date of first LTC / PCH admission to the date of last LTC / PCH separation.
  
  
• Geographic Location of Facility can be determined by converting the facility number into a municipal code, and then using the available conversion formats (the same as for any hospital facility in the province).
  
  Links to related concepts, glossary terms and other relevant information are provided at the end of this concept.

Data Sources

The following describes the two LTC databases available in the Manitoba Population Research Data Repository. The description includes a list of files in each database, identifies some of the most important variables in each file, describes how these files can be used for your research, identifies some commonly used variables, and lists some data limitations / cautions related to each database.

I - Manitoba Health Long Term Care (LTC) Utilization Database

The Manitoba Health Long Term Care (LTC) Utilization database is a database maintained by Manitoba Health that contains data for the entire province beginning in 1973. It includes records of services provided by LTC facilities in Manitoba, more recently including records for hospital patients in LTC-designated beds awaiting placement in a PCH facility. This data consists of four main files that can be linked together by scrPHIN (Scrambled PHIN) and the corresponding dates.

1. Assessments File
   
   
   • contains data on each individual assessed for admission into LTC and while in LTC. The data also includes people assessed but never admitted into LTC.
     
   • variables include: level of care required, location indicator and date of the assessment. NOTE: The changes in levels of care for existing PCH residents are not consistently recorded in recent years.
     
   • can be used to determine Panel to PCH information, and the waiting time from panel to LTC / PCH admission.
   
   
2. Admissions File
   
   
   • contains data for individuals admitted to any LTC facility in Manitoba.
     
   • variables include: level of care, location indicator, assessment and admission dates. This also includes respite care admissions (Level of Care = 5).
     
   • can be used to determine LTC residency, LTC admissions, waiting time, and length of stay (LOS).
   
   
3. Separations File
   
   
   • contains data for separations (discharges) from LTC facilities and does not include respite care records. Separations can be linked to admissions, using scrambled PHIN, assessment and admission dates. For residents still admitted at the time of the Separation file creation, separation records will be missing. For longer hospital stays (> ? of days), there will be a PCH separation record generated and a new admission record will appear once/if the resident returns to the PCH after hospital discharge.
     
   • variables include: location indicator, assessment and separation dates, and type of separation (e.g. ’9’ is for separation type due to death).
     
   • can be used to determine LTC residency, LTC separations, and length of stay (LOS).
   
   
4. Rate Change Transactions File
   
   
   • contains data on the per diem rate paid by an individual for PCH services, date, and a rate appeal code.
     
   • file can be used to determine the PCH residents’ per diem rate and approximate income level.

Commonly Used Variables

• Demographics - Manitoba Health adds sex, date of birth and limited postal code and municipality code information to the LTC Utilization data from the Manitoba Health Insurance Registry data when the LTC database is generated.
  
  
• Levels of Care - in a PCH - this is a classification system for PCH residents used to define the extent of their dependence, and to approximate the amount of daily nursing care they may require. Residents assigned to Level of Care I are estimated to require 0.5 hours of nursing care, residents assigned to Level of Care II - 2.0 hours of care, and those assigned to Level of Care III or IV - at least 3.5 hours of nursing care during a 24-hour period.
  
  Note: Analysis of Level of Care at time of LTC admission has a broader scope of interpretation - please read the Level of Care - LTC Admissions glossary term for more information.
  
  
• Facility Number - facility numbers ranging from 500 to 900 in the LTC database represent licensed PCH facilities. Levels of care for residents in these facilities will range from 1 to 4. in some cases, Level of Care = 5 represents respite care.

  Special Considerations: for Riverview, Deer Lodge, Misericordia Place, Companion Care (PCH # 507) and other Facility Numbers.
  
  

  • Riverview PCH is facility # 587 and Riverview CC is facility/hospital # 6.
    
  • Deer Lodge PCH is facility # 699 and Deer Lodge CC is facility/hospital # 19.
    
  • Misericordia Place PCH is facility #509. Misericordia Place facility # 4 is not a licensed PCH, but in many respects functions like one.
    
  • Companion Care PCH # 507 is "unknown location".

  
  The residents of these "special consideration" facilities are part of the WRHA MDS 2.0 data, and can be included in a definition of LTC by specific facility number (< 500) and/or level of care = 6 (CC).

• Dates: - admission, separation and assessment dates are used to determine LTC / PCH residency, new admissions versus existing residents, discharges, transfers and length of stay (LOS).

Data Limitations / Cautions

The process of data collection, acquisition, as well as some formats and values in this database underwent changes over time. Here are some of the highlights:


• Changes in Data Acquisition Process - historically, each new set of MH LTC data completely replaced the previously received data acquisition. However, since year (??) only new records and changes/corrections to pre-existing data are received and installed in the Data Repository. This means that selection of data and the process of removing duplicate records can give slightly different results depending on sorting order and/or variables used in such sorting. The overall population effect of these differences is usually small.
  
  
• Changes in Data Coding - between 1997 and 2002, admission Levels of Care = 7, 8 and 9 were used to designate "waiting in hospital for placement- - for respite, PCH, or CC, respectively. Since 2003, such records have Levels 5, 1-4, 6 recoded, with facility/hospital number <500.
  
  
• Other Considerations - with the introduction of Supportive Housing as alternative to PCH placement, the record with original Panel to PCH date might not be available until the actual PCH placement.

SAS Code Examples for LTC Utilization Data

The following SAS code examples for working with the LTC Utilization data are available in the SAS Code and Formats section below (Internal Access Only):


• LTC Utilization Admissions SAS Code - this code extracts data on Long Term Care (LTC) admissions into licensed PCH or PCH bed in any facility, or admissions into any type of LTC facility (such as PCH, PCH bed in hospital, or CC facility) except for respite care.
  
• LTC Utilization Panel to PCH SAS Code - this code identifies outcome data (Panel Status) on the Panel to Personal Care Home (PCH) process for admission to PCH
  
• LTC Utilization Residents SAS Code - this code extracts data on Long Term Care (LTC) and Personal Care Home (PCH) residents.

See the Manitoba Health Long Term Care (LTC) Utilization Data Description for more general information about this database.

II - Winnipeg Regional Health Authority (WRHA) LTC Minimum Data Set (MDS) Database

The Winnipeg Regional Health Authority (WRHA) LTC Minimum Data Set (MDS) database is a database maintained by the Winnipeg Regional Health Authority (WRHA) that contains data for Winnipeg only, beginning in 2000. It consists of five types of files: admissions, discharges, re-entries and full and quarterly assessments. The assessments include a wide array of information about the resident. Full assessments are typically completed on admission to a facility and then once per year. However, some facilities choose to complete Full Assessments on a quarterly basis (every 3 months). All forms include basic demographic information such as birthdate, sex, and scrambled PHIN. All the data from these files can be linked together by scrPHIN (Scrambled PHIN), and organized chronologically by date.

1. Admissions File
   
   
   • contains data on individuals admitted to Winnipeg PCHs.
     
   • variables include: individual-level demographic and personal health data, including: marital status; language; education level; postal code before 1st admission, at 1st admission and at current admission; facility / service admitted from; and data on specific medical conditions.
   
   
2. Discharge File
   
   
   • contains data on individuals discharges from Winnipeg PCHs.
     
   • variables include: date of discharge and discharge disposition.
   
   
3. Full MDS Assessments File
   
   
   • contains comprehensive assessment data for each individual assessed for admission to PCH, and on a yearly (or more frequent) basis.
     
   • variables include individual-level:
     
     
     • medical history and limited health care use history;
       
     • Activities of Daily Living (ADL) measures: (e.g.: movement in bed, transfers, dressing, personal hygiene, etc.) necessary for normal self-care.
       
     • levels of independence in recreation, mealtime, and other daily activities;
       
     • clinical and health care information (e.g.: chronic conditions, advanced directives (living will, DNR, etc.), memory, weight, height, dietary considerations and therapies (speech, OT, PT, etc.)).
   
   
4. Quarterly MDS Assessments
   
   
   • contains data on quarterly individual-level assessments. After an initial full assessment upon admission to the LTC facility, assessments are completed quarterly thereafter to capture changes in health and functional performance and record some of the events / health care use between assessments.
     
   • variables include: those similar to the Full Assessment (see above).
     
   • NOTE: Quarterly MDS assessments typically have less information than Full MDS assessments.
   
   Special Considerations for Assessments
   
   
   • some facilities choose to complete Full Assessments on a quarterly basis.
     
   • all data fields are automatically populated from the default values or in case of non-first form, by previously filled values. Thus, there are no explicit missing values in this database. Missing dates are coded by default SAS date January 1, 1960.
     
   • forms can be completed over several days and there are locked (finalized) and unlocked (still in process) forms in the database. As a rule, MCHP only use locked MDS 2.0 records during analysis.
   
   
5. Facility File
   
   
   • contains data on WRHA LTC facilities.
     
   • variables include: the WRHA MDS facility number (variable = UniqFacilityID), address and name of the facility. PCH facility number can be derived from the first three digits of a variable MDSINNUM and this value will corresponds to the facility number coded in MH LTC database.

Data Limitations / Cautions

• The data only contains information from LTC facilities in Winnipeg.
  
• Facility data comes in a separate file and has changed in format over time.

SAS Code Examples for WRHA LTC MDS Data

The following SAS code examples for working with the WRHA LTC MDS data are available in the SAS Code and Formats section below (Internal Access Only):


• LTC MDS Add Facility SAS Macro - this code adds additional facility information (PCH number, location address, etc.) to any MDS table.
  
• LTC MDS Assessments SAS Code - this code extracts MDS Assessment records from the FULL and QUARTERLY Assessment datasets.

See the Winnipeg Regional Health Authority (WRHA) LTC Minimum Data Set (MDS) Data Description for more general information about this database.