title: Home care or long-term care? Setting the balance of care in urban and rural Northwestern Ontario, Canada.
abstract: The objective of the study was to determine the extent to which community care packages could be provided at a lower cost than facility-based long-term care (LTC) for 864 individuals on the LTC waiting list in urban and rural parts of Northwestern Ontario, Canada. A sequential mixed methods design was used entailing a retrospective chart review, the formation of case vignettes, the creation of community care packages with an 'expert panel' of care managers, the costing of care packages and the calculation of potential diversion rates from LTC. Data collection took place in Northwestern Ontario between the months of March and June 2008. Eight per cent of individuals in the urban area and 50% of individuals from the rural areas could potentially be safely diverted to the community and provided with a community care package at a cost lower than facility-based LTC. There is potential for home and community care to substitute for more costly long-term care, but doing so requires building capacity in this sector, particularly in rural areas, which are currently underserviced. Reconfiguring the 'balance of care' may lead to long-term cost efficiencies for an ageing population.
authors.affiliation: Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Health, Toronto, Ontario, Canada. kkuluski@bridgepointhealth.ca
authors.forename: Kerry
authors.initials: K
authors.lastname: Kuluski
authors.forename: A Paul
authors.initials: AP
authors.lastname: Williams
authors.forename: Whitney
authors.initials: W
authors.lastname: Berta
authors.forename: Audrey
authors.initials: A
authors.lastname: Laporte
mesh_terms: D017046:Cost Savings; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D008507:Medically Underserved Area; D009864:Ontario; D012189:Retrospective Studies; D012424:Rural Population; D014505:Urban Population