Patterns of home care assessment and service provision before and during the COVID-19 pandemic in Ontario, Canada

Chi-Ling Joanna Sinn; Heebah Sultan; Luke Andrew Turcotte; Caitlin McArthur; John P Hirdes

doi:10.1371/journal.pone.0266160

Patterns of home care assessment and service provision before and during the COVID-19 pandemic in Ontario, Canada

PLoS One. 2022 Mar 30;17(3):e0266160. doi: 10.1371/journal.pone.0266160. eCollection 2022.

Authors

Chi-Ling Joanna Sinn¹, Heebah Sultan^{2

3}, Luke Andrew Turcotte¹, Caitlin McArthur⁴, John P Hirdes¹

Affiliations

¹ School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ Ontario Health, Toronto, Ontario, Canada.
⁴ School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

Objective: The objective was to compare home care episode, standardised assessment, and service patterns in Ontario's publicly funded home care system during the first wave of the COVID-19 pandemic (i.e., March to September 2020) using the previous year as reference.

Study design and setting: We plotted monthly time series data from March 2019 to September 2020 for home care recipients in Ontario, Canada. Home care episodes were linked to interRAI Home Care assessments, interRAI Contact Assessments, and home care services. Health status measures from the patient's most recent interRAI assessment were used to stratify the receipt of personal support, nursing, and occupational or physical therapy services. Significant level and slope changes were detected using Poisson, beta, and linear regression models.

Results: The March to September 2020 period was associated with significantly fewer home care admissions, discharges, and standardised assessments. Among those assessed with the interRAI Home Care assessment, significantly fewer patients received any personal support services. Among those assessed with either interRAI assessment and identified to have rehabilitation needs, significantly fewer patients received any therapy services. Among patients receiving services, patients received significantly fewer hours of personal support and fewer therapy visits per month. By September 2020, the rate of admissions and services had mostly returned to pre-pandemic levels, but completion of standardised assessments lagged behind.

Conclusion: The first wave of the COVID-19 pandemic was associated with substantial changes in Ontario's publicly funded home care system. Although it may have been necessary to prioritise service delivery during a crisis situation, standardised assessments are needed to support individualised patient care and system-level monitoring. Given the potential disruptions to home care services, future studies should examine the impact of the pandemic on the health and well-being of home care recipients and their caregiving networks.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Home Care Services*
Hospitalization
Humans
Ontario / epidemiology
Pandemics

Grants and funding

This work was supported in part with funding from the Ontario Ministry of Health and Long-Term Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.