Not Just For Canada’s Elderly: One in five continuing care patients in hospital is younger than 65

CIHI offers a first look into continuing care in Canadian hospitals and nursing homes

March 22, 2006-Today, for the first time, the Canadian Institute for Health Information (CIHI) is releasing information on continuing care – a sector of the health care system about which very little is known. As Canada’s population ages, the health system is focusing more on the care delivered to the elderly and to those with chronic health conditions. Facility-Based Continuing Care in Canada, 2004-2005 sheds light on this type of care, offering a snapshot of continuing care facilities and their patients. Interesting findings include the fact that one in five continuing care patients being cared for in Ontario hospitals is under the age of 65.

“Until very recently, there has been no standardized information collected across Canadian provinces and territories on health services beyond acute hospital care,” says Nancy White, CIHI’s Manager of Home and Continuing Care. “This report provides a valuable picture of what is happening in the area of continuing care in hospitals and nursing homes, where a new national standard for assessing a patient’s care needs is also providing critical information for planning and quality improvement.”

In continuing care facilities, the goal of care may not be to cure, but to allow the patient to remain as healthy as possible, for as long as possible. The data contained in this report present an emerging profile of the characteristics of continuing care patients and the services they receive in hospital-based facilities and in nursing homes. The two settings accommodate a wide range of needs, and this report looks at how the health system responds to those needs. As the first information of its kind from CIHI, this analysis includes data from facilities in Ontario and Nova Scotia. Other provinces and territories are scheduled to begin contributing data between 2006 and 2008.

Many hospital-based continuing care patients experience daily pain

Patients in hospital-based continuing care are generally admitted from an acute care hospital bed, and not all of them are elderly-nearly one in five (18%) was younger than 65 in 2004–2005. According to the report, 22% of assessed patients were totally dependent on others for the basic activities of daily living, such as personal hygiene, eating and moving around. Most (82%) had complex and unstable health conditions, and nearly half (47%) experienced some degree of unrelieved pain, with 10% in severe daily pain.

Signs of depression were reported in nearly one quarter (24%) of patients. The report found that, among continuing care patients who had been in the hospital for more than 15 weeks, 59% had limited or no social involvement, likely related to their serious health conditions or disabilities. This finding was based on a comprehensive assessment performed by nurses or other caregivers that measures patients’ ease in interacting with others, their participation in activities and their ability to establish goals for themselves. In 2004–2005, 13% of hospital-based continuing care patients were transferred to other hospital beds, primarily acute care, while 22% went home and 27% died in hospital.

Nursing home residents show higher levels of social engagement, and more than half are 85 or older

Data collected from a sample of nursing homes in Nova Scotia show that, in 2004–2005, about one in four residents was admitted directly from home. Nursing home residents were, on average, eight years older than their counterparts in hospital-based care; however, their health was more stable and they were less likely to be totally dependent on others for the activities of daily living (15%). Nursing home residents were also more likely to be assessed as pain-free and had a higher level of social involvement than those in hospital. In 2004–2005, one third (33%) of nursing home residents were discharged to hospital and 12% died in the facility.

CIHI working towards more comprehensive continuing care information

One way CIHI is making progress toward filling information gaps is by developing systems that not only collect valuable information for the Canadian public and policy-makers, but also allow for immediate clinical feedback to caregivers. Working with interRAI, an international, non-profit research organization that develops clinical assessment instruments, CIHI supports tools that identify potential patient safety issues (prone to falls, takes certain medications and is somewhat confused, for example), while at the same time collecting data for planning and monitoring the quality of care.

Over the next three years, Alberta, British Columbia, Manitoba, Saskatchewan and the Yukon Territory are expected to begin submitting continuing care data to CIHI. “Future reports will extend the analysis offered today to new jurisdictions and will also begin to explore special topics, such as safety and quality of care,” says White. “As more data become available over the next few years, there will be opportunities to more fully understand the spectrum of continuing care and the people it serves.”

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

Figures and Tables