As the population ages, policymakers are increasingly looking to augment home care services as a means of reducing the growing need for long-term institutional care. People suffering from dementia are among those putting the greatest demand on the long-term care system, and the prevalence of dementia is increasing dramatically with an aging population. This research project seeks to determine the predictive factors and health workforce implications associated with the transition from receiving home care services to institutionalization in long-term care facilities (i.e., nursing homes) for people with dementia. A retrospective, population-based cohort study of community dwelling adults with dementia in Ontario will be undertaken using routinely collected health administrative data. From these data, we will develop a predictive model to estimate the time between home care initiation and placement in a long-term care institution. The multivariable model will permit the identification and contribution of key predictors associated with this primary outcome. Among the predictors, factors that are modifiable are of greatest interest as they can potentially be targeted to delay the transition from home to long-term care, allowing people to be cared for longer in the community. Of particular interest is the relationship between services provided by the health workforce and how long people with dementia can remain adequately supported at home, and reciprocally how policies that increase the emphasis on home care implicate the health workforce. To this end, the contribution of formal and informal caregivers (in terms of level and mix of care) to delaying the home-to-institutional care transition will be examined to describe different “care packages” and their impact on transitions of care. Taken together, these results will be of use to inform policymakers in capacity planning and in determining where investments should be targeted to maintain people with dementia safely at home, along with the associated health workforce implications.
