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Background: Because there are no standardized reporting systems specific to residents of retirement homes in North America, little is known about the health of this distinct population of older adults. We evaluated rates of health services use by residents of retirement homes relative to those of residents of long-term care homes and other populations of older adults. Methods: We conducted a retrospective cohort study using population health administrative data from 2018 on adults 65 years or older in Ontario. We matched the postal codes of individuals to those of licensed retirement homes to identify residents of retirement homes. Outcomes included rates of hospital-based care and physician visits. Results: We identified 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings. Compared to residents of long-term care homes, residents of retirement homes had significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), alternate level of care (ALC) days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68), but a significantly lower rate of primary care visits (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14). Interpretation: Residents of retirement homes are a distinct population with higher rates of hospital-based care. Our findings can help to inform policy debates about the need for more coordinated primary and supportive health care in privately operated congregate care homes., In the continuum of care services and settings for older adults lies home care at one end and long-term care at the other. (1) Home care services may include, but [...]

CONTEXTE : L'epidemiologie de l'infection au SRAS-CoV-2 dans les residences pour aines (offrant une aide a la vie autonome), est pour une bonne part inconnue. Nous avons etudie le lien entre les caracteristiques des residences et des communautes avoisinantes et le risque d'eclosion de SRAS-CoV-2 dans les residences pour aTnes depuis le debut de la premiere vague de la pandemie de COVID-19. METHODES : Nous avons procede a une etude de cohorte retrospective dans la population des residences pour aTnes certifiees en Ontario, au Canada, entre le 1er mars et le 18 decembre 2020. Notre parametre principal etait toute eclosion de SRAS-CoV-2 ([greater than or equal to] 1 cas confirme parmi les residents ou le personnel au moyen d'un test d'amplification des acides nucleiques). Nous avons utilise la methode des risques proportionnels avec predicteurs chronologiques pour modeliser les liens entre les caracteristiques des residences et des communautes avoisinantes et les eclosions de SRAS-CoV-2. RESULTATS : Notre cohorte a inclus l'ensemble des 770 residences privees pour aTnes (RPA) certifiees en Ontario qui hebergeaient 56 491 residents. On a denombre 273 (35,5 %) residences pour aines qui ont connu 1 eclosion de SRAS-CoV-2 ou plus; 1944 residents (3,5 %o) et 1101 employes (3,0 %o) ont contracte l'infection. Ces cas etaient inegalement distribues entre les residences. En effet, 2487 cas parmi les residents et le personnel (81,7 %o) sont survenus dans 77 residences (10 [degrees]%). Le rapport de risque ajuste d'une eclosion de SRAS-CoV-2 dans une residence a ete clairement associe aux etablissements qui avaient une grande capacite d'accueil, qui comportaient des unites de soins de longue duree, qui appartenaient a de plus grandes bannieres et offraient plusieurs services sur place, qui se trouvaient dans des regions marquees par une hausse de l'incidence regionale de SRAS-CoV-2 et ou la concentration ethnique a l'echelle de la communaute etait superieure. INTERPRETATION : Certaines caracteristiques facilement identifiables des residences pour aTnes sont associees de maniere independante aux eclosions de SRAS-CoV-2 et peuvent faciliter devaluation des risques et orienter la priorisation de la vaccination., Les adultes ages fragiles qui vivent dans des milieux de vie collectifs ont ete au centre de la pandemie de COVID-19 au Canada et ailleurs dans le monde (1,2). Les [...]

BACKGROUND: The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic. METHODS: We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection ([greater than or equal to] 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home--and community-level characteristics and outbreaks of SARS-CoV-2 infection. RESULTS: Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration. INTERPRETATION: Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination., Frail older adults living in congregate care settings have been at the centre of the COVID-19 pandemic in Canada and internationally. (1,2) Long-term care facilities--whose residents are the congregate living [...]

BACKGROUND: The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. METHODS: We conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the pre vious week. The cohort was stratified according to whether patients had ongoing home care needs ('long stay') or short-term home care needs ('short stay'). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. RESULTS: A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. INTERPRETATION: Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation., Older adults are more likely to use the emergency department, have longer lengths of stay in the emergency department and are more likely to be admitted to hospital from the [...]

RÉSUMÉ:La législation, dans de nombreuses juridictions, nécessite les établissements des soins de longue durée (SLD) d'avoir une infirmière en service 24 heures par jour, 7 jours par semaine. Bien que la recherche considérable existe sur l'intensité SLD de la dotation en personnel infirmier, il n'existe pas de la recherche empirique relative à cette exigence. Notre étude rétrospectif d'observation a comparé des installations en Saskatchewan avec 24/7 RN couverture aux établissements offrant moins de couverture, complétées par divers modèles de dotation des postes de nuit. Les ratios de risque associés à moins de 24/7 couverture RN complété de la dotation infirmière autorisé de nuit, ajusté pour l'intensité de dotation en personnel infirmier et d'autres facteurs de confusion potentiels, étaient de 1,17, IC 95% [0,91, 1,50] et 1.00, IC à 95% [0,72, 1,39], et avec moins de couverture 24/7 RN complété avec soin par aides personnels de nuit, les ratios de risque étaient de 1,46, IC 95% [1,11, 1,91] et 1,11, IC 95% [0,78, 1,58], pour les patients hospitalisés et de visites aux services d'urgence, respectivement. Ces résultats suggèrent que l'utilisation des soins de courte durée peut être influencée négativement par l'absence de la couverture 24/7 RN.ABSTRACT:In many jurisdictions, legislation requires long-term care (LTC) facilities to have a registered nurse on duty 24 hours a day, seven days per week. Although considerable research exists on LTC nurse staffing intensity, no empirical research on this requirement exists. Our retrospective observational study in Saskatchewan compared facilities with 24/7 RN coverage to facilities with less coverage supplemented with various night-shift staffing models. Adjusted for nurse staffing intensity and other potential confounders, risk ratios associated with less-than-24/7 RN coverage supplemented with licensed practical nurse night-shift staffing were 1.17, 95% CI [0.91, 1.50] and 1.00, 95% CI [0.72, 1.39]; and with less-than-24/7 RN coverage supplemented with care aide night-shift staffing, risk ratios were 1.46, 95% CI [1.11, 1.91] and 1.11, 95% CI [0.78, 1.58], for inpatient hospital admissions and Emergency Department visits respectively. Findings suggest that acute services utilization may be negatively influenced by the absence of 24/7 RN coverage.

The case-mix system Resource Utilization Groups version III for Home Care (RUG-III/HC) was derived using a modest data sample from Michigan, but to date no comprehensive large scale validation has been done.