Developing and testing theoretical models of factors influencing older persons’ transitions to facility-based continuing care settings
Creators: Tate, Kaitlyn C
Publisher: name: University of Alberta Library
Year: 2022

<p>Background: Ensuring community and health services are available so older persons (&gt;65 years) can remain in their homes as their care needs change is a global issue. Internationally, initiatives are being developed for better integrated community and home health programs to prevent and improve transitions from home to different levels of facility-based care (FBC) settings (which include long-term care (LTC) and designated supportive living (DSL) facilities). More research is needed on modifiable factors that influence transitions to FBC. Improving our understanding of how health services influence transitions in different contexts will guide the development of effective preventative health programs to reduce or delay transitions to FBC.<br>
Purpose: The purpose of this dissertation is to contribute towards our understanding of how to effectively reduce or delay transitions from home to FBC. The aims of the four research phases were to: 1) synthesize the available evidence on sociodemographic, health service use, client health and function factors that influence older persons’ transitions from home living to FBC; 2) examine which client factors (socio-demographic, health service use, health, and function) influenced older persons’ time to transition from home living to LTC and DSL; 3) generate a theoretical model for transitions to FBC through theory integration and specification and 4) develop and test theoretical models of factors influencing older persons’ time to transitions to different levels of FBC.<br>
Methods: I employed four sequential phases: 1) a scoping review on factors influencing transitions to FBC; 2) a time-to-event analysis on factors influencing risk of transition to LTC or DSL settings in Alberta; 3) theory integration and specification of the Meleis’ Health Transition (MHT) model and 4) structural equation modeling to test context-specific models, on factors influencing time to transition to LTC or DSL settings.<br>
Findings: Scoping review findings highlighted that consistent risk factors for transition are age, cognitive/functional impairments, and caregiver burden. Phase 2 results demonstrated that clients who were visited by home health care aides (HCAs) once in the last 7 days transitioned to DSL settings significantly later than those with no visits. Clients receiving physical therapy services once or more a week transitioned to LTC significantly later than those who did not receive these services. For either transition type, institutionalizations happened significantly sooner if the client’s caregiver was unable to continue and if clients socialized less. Based on Phase 1 and Phase 2 findings, I developed context-specific theoretical models, informed by the MHT model. Structural equation modeling results demonstrated that context-specific adaptations fit the empirical data for three transition types (transitions to LTC, and the highest levels of care for DSL: DSL4 and DSL4-D (which specializes in dementia care). The models explained 32% variance for LTC transitions, 13% for DSL4-D transition and 20% for DSL4 transitions, although general effects were small. Increased hospitalizations, greater change in functional impairment and increased income significantly delayed transitions to LTC through direct effects. Increases in care aide visits and day program hours over time significantly, albeit modestly, delayed transitions to DSL4-D but had no significant effects on time to transition to DSL4.<br>
Conclusions: This work advanced context-specific theory development for transitions to FBC settings. Certain increases in home HCA hours can significantly delay time to transition for those transitioning to DSL facilities. Given the diverse nature of HCA work in home care, we need to explore which types of HCA services delay transitions to FBC. Although increases in physical therapy services from initial to last RAI-HC© assessment did not have a significant effect on transition time for LTC in Phase 3 findings, Phase 2 findings support that a preventative approach in home care of prescribing exercises could be explored. Phase 3 findings highlight that increased hospitalizations significantly decrease time to transition to LTC. More research is needed on transitions to FBC that focuses on caregiver burden, the nature of hospital care, home care services, practical care needs (e.g. home maintenance, pet care needs), marginalized populations and transitions to DSL settings. However, information needed to address these issues are not routinely collected and included in administrative healthcare data sets, substantially limiting our understanding of these issues on a population-level. Research involving primary data collection is necessary, and critical discussion is required on what we currently measure routinely.</p>