Transcript Slide 1

Provincial Variations in PubliclyFunded Nursing Home Bed
Supply in Canada: Exploring
What “Matters”
Saskia Sivananthan, Malcolm Doupe, Margaret McGregor
Study Rationale
• Population aging
• While rates of institutionalization are
decreasing, nursing homes are still a common
venue for care of the very frail who are unable
to live independently
• Literature focussed on bed projections
• Little work examining the factors that relate to
variation in bed supply nor how the variation
affects the healthcare system more generally
How many receive care in institutions?*
Share of older people receiving care in institutions (most recent date)
Institutional care
covers only a small
percentage of older
people
6.5%
Source: Huber et al. (2009 forthcoming) Own calculations based on OECD, NOSOSCO , WHO, Eurostat and national
sources.
15-16/09/2009
Conference on Healthy and Dignified
Ageing – Swedish Presidency of the EU
Presentation by Bernd Marin
First Study Goal
• An exploration of factors related to provincial
variation in Canada’s publicly funded nursing
home (NH) bed supply
Are bed numbers related to variation in
distribution of oldest seniors (85+)?
Is variation bed supply related to provincial
wealth?
Is there an inverse relation of bed supply and
provincial investment in home care?
Second Study Goal
• Explore the extent to which publicly-funded
bed supply is related to healthcare system
“efficiency”
Is publicly-funded bed supply inversely related to
ALC days waiting admission to a nursing home bed
Methods
Data Sources
Need for comparable data from valid sources!
 Statistics Canada – Demographics, Gross Domestic
Product
CUPE - (Irene Janzen, Janice Murphy) – NH bed #
 CIHI - All other measures (home care*, Alternate
Level of Careˆ)
 Most data from 2008 - 2011
* Public-Sector Expenditures and Utilization of Home Care Services
in Canada: Exploring the Data; CIHI 2007
ˆ Obtained directly from CIHI
Definitions
• Demographics, Publically funded NHs, Bed Supply
 Focus on people 85+ years old – majority NH users from
both a population and user-based perspective
 Facilities funded by government to provide 24/7 care includes respite, for profit, not-for-profit sector
 Bed Supply: density (i.e., # of beds per capita).
• Alternate Level of Care (ALC) Days
 Hospitalized people who no longer require acute care
 ALC people / days waiting for nursing home admission.
Analytic Approach
• Descriptive reports & regression analysis
 Extent that provincial variation in bed supply is related to
population size 85+, wealth, etc.
 Identifies provinces with > / < than average bed supply
Approach allows us to explain (or not) inter-provincial
trends in nursing home bed supply.
Results
Population Distribution Across Canada - 1
40
% Across Provinces
35
N~ 34.5 million
All Ages
30
25
20
15
10
5
0
British
Columbia
Alberta
Manitoba
Saskatchewan
Ontario
Quebec
New
Newfoundland Nova Scotia Prince Edward
Brunswick
& Labrador
Island
Ontario & Quebec house ~ 2/3s of our population, plus ~ 1/4 in BC & Alberta.
Manitoba, Saskatchewan, & Atlantic Canada house 13.5% of our population.
Population Distribution Across Canada - 1
40
% Across Provinces
35
All Ages
N~ 34.5 million
30
65-74
25
75-84
20
85+
15
10
5
0
British
Columbia
Alberta
Manitoba
Saskatchewan
Ontario
Quebec
New
Newfoundland Nova Scotia Prince Edward
Brunswick
& Labrador
Island
This is true also for older adults, except that relatively:
i)
ii)
Fewer live in Alberta
More live in Quebec, BC
# of NH Beds / 1000 population 85+
Publically Funded NH Bed Supply in Canada
380
360
N~ 198,000 Publically Funded NH Beds
340
320
300
280
260
240
220
200
Canada
British
Columbia
Alberta
Manitoba
Saskatchewan
Ontario
Quebec
New
Brunswick
Newfoundland
& Labrador
NH Bed supply varies across Canada, especially for people 85+ years old:
i) Highest in MB, Sask, Nova Scotia, PEI
ii) Lowest in New Brunswick, BC, Alberta
Nova Scotia
Prince Edward
Island
Besides Population Size – what factors could influence NH
Bed Supply?
Canada
BC
AB
MB
SASK
ONT
QB
New B
NFDL
&L
Nova
Scotia
PEI
Gross Domestic Product
Value per capita
$47,112
$44,388 $69,754 $43,347 $60,084 $45,824 $40,029 $38,987 $54,966 $38,327 $34,387
Home Care Expenditures
(1997 dollars)
Value per capita
$93.6
$86.8
$91.0 $142.2 $82.0
$99.8
$79.9 $163.4
N/A
$116.7 $55.5
Alternate Level of Care Days Waiting Admission to a NH
% of all hosp
patients with 1+
ALC day, Waiting
Admission to a NH
Of all hosp days, %
ALC Waiting
Admission to a NH
3.2
3.5
2.2
4.3
5.7
4.7
3.4 11.9
4.6
3.2
N/A
6.0
5.1
N/A
2.6
1.2
N/A
4.7
12.4 4.5
N/A
6.8
Population Size 85+ – how does it impact NH Bed Supply?
115.0
NH Bed Supply (# / 1,000 85+)
110.0
↑ than average NH
bed supply based on
population size
105.0
100.0
95.0
90.0
85.0
↓ than average NH
bed supply based on
population size
80.0
R² = 0.09; NS
75.0
70.0
0
100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000
# of people 85+ years old
Population Size 85+ – how does it impact NH Bed Supply?
380
PEI
2894, 363.2
Bed Supply (# / 1,000 people 85+ years old)
360
MB
28619, 338.3
340
SASK
26409, 324.7
320
Nova S
ONT
21492, 319.7
300
262051, 297.2
NFLD & L
8719, 303.9
280
QC
R² = 0.09; NS
159195, 287.9
260
New B
AB
BC
54135, 267.2
99175, 264
17247, 256.7
240
220
0
25,000
50,000
75,000
100,000 125,000 150,000 175,000 200,000 225,000 250,000 275,000 300,000
# of people 85+ years old
Population Size 85+ – how does it impact NH Bed Supply?
380
PEI
2894, 363.2
Bed Supply (# / 1,000 people 85+ years old)
360
MB
28619, 338.3
340
Size Doesn’t
Matter (R2=.06)
SASK
26409, 324.7
320
Nova S
21492, 319.7
300
NFLD & L
8719, 303.9
280
R² = 0.09; NS
260
240
220
0
25,000
50,000
75,000
100,000 125,000 150,000 175,000 200,000 225,000 250,000 275,000 300,000
# of people 85+ years old
Population Size 85+ – how does it impact NH Bed Density?
380
PEI
2894, 363.2
Bed Supply (# / 1,000 people 85+ years old)
360
MB
28619, 338.3
340
SASK
26409, 324.7
320
Nova S
21492, 319.7
300
Maybe it does
(R2=.91)
NFLD & L
ONT
262051, 297.2
8719, 303.9
280
QC
R² = 0.09; NS
159195, 287.9
260
New B
AB
BC
54135, 267.2
99175, 264
17247, 256.7
240
220
0
25,000
50,000
75,000
100,000 125,000 150,000 175,000 200,000 225,000 250,000 275,000 300,000
# of people 85+ years old
GDP & NH Bed Supply?
380.0
PEI
$34,387, 363.2
Bed Supply (# / 1,000 population 85+)
360.0
MB
$43,347, 338.3
340.0
SASK
Nova Scotia
$60,084, 324.7
$38,327, 319.7
320.0
NFDL & L
$54,966, 303.9
300.0
280.0
QB
ONT
$40,029, 287.9
$45,824, 297.2
260.0
R² = 0.08; NS
BC
AB
$44,388, 264
$69,754, 267.2
New B
$38,987, 256.7
240.0
220.0
30,000
35,000
40,000
45,000
50,000
55,000
Per Capita GDP
60,000
65,000
70,000
75,000
Per Capita Home Care Expenditure & NH Bed Supply?
380.0
PEI
$55, 363.2
360.0
MB
Bed Supply (# / 1000 population 85+ years old)
R2=.25
340.0
$142, 338.3
SASK
$82, 324.7
320.0
Nova Scotia
$117, 319.7
300.0
ONT
QB
$80, 287.9
280.0
$100, 297.2
AB
260.0
BC
R² = 0.10; NS
R2=.27
$91, 267.2
New B
$87, 264.1
$163, 256.7
240.0
220.0
200.0
180.0
50
70
90
110
130
150
170
Per Capita Home Care Expenditure
190
210
230
Impact of NH Bed Supply on ALC Days
14.0
New B
256.7, 12.4
% of all Hospital Days that are ALC days waiting NH
Admission
12.0
MB
338.3, 11.9
10.0
R² = 0.03; NS
8.0
PEI
363.2, 6.8
SASK
6.0
BC
264.1, 4.7
4.0
324.7, 6.0
ONT
R2=.85
297.2, 5.1
NFDL & L
287.9, 4.5
AB
267.2, 3.4
2.0
0.0
240
260
280
300
320
340
360
Bed Supply (# / 1000 population 85+years old)
380
In Summary
Extent that NH Bed Supply is Impacted by
NH Bed
Supply
Population Size
(# of 85+ year olds)
GDP
Home Care
Expenditures
ALL
↔
↔
↔
↔
MB, SASK,
PEI, Nova
Scotia,
NFLD&L
↑
No obvious
relation
No obvious
relation
More HC
↓ bed supply
Ontario, AB,
BC, New
Brunswick
↓
More people
↑bed supply
No obvious
relation
More HC
↓ bed supply
Provinces
Greater NH Bed Supply is associated with more ALC Days
waiting admission – Manitoba and NB are outliers
Discussion: Why is NH Supply
Positively Associated with % ALC
Days waiting NH Admission?
Discussion: “Stuff” not measured that
may matter
• The effect of different policy decisions by
provincial governments in power
• Differences in how homecare is deployed
(post-op vs. longterm substitution for NH care)
• Unmeasured regulatory factors?
Provincial “bed hold” policies?
Policy on NH “leeway” to refuse admission?
“First available bed” policies?
Block vs. case-mix adjusted payment systems?