title: Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision.
abstract: OBJECTIVE
  To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System.
  
  
  METHODS
  Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n = 299 262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment.
  
  
  RESULTS
  Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision.
  
  
  CONCLUSIONS
  Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population. Implications for Rehabilitation For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community. Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it. This article used clinical assessment data to identify the predictors of and barriers to rehabilitation services for older adults in the Ontario Home Care System. Barriers of PT included dementia diagnosis and French as a first language. Barriers to OT included dementia diagnosis. Policies and practices related to service provision for older adults should be reconsidered if we are going to meet the demands of aging populations and increasing rates of functional and cognitive impairments.
authors: Geriatric Medicine Research, Dalhousie University , Halifax, Nova Scotia , Canada .
authors: Joshua J
authors: JJ
authors: Armstrong
authors: Mu
authors: M
authors: Zhu
authors: John P
authors: JP
authors: Hirdes
authors: Paul
authors: P
authors: Stolee
mesh_terms: D000203:Activities of Daily Living; D000288:Administrative Personnel; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000628:therapy; D003704:Dementia / Q000175:diagnosis; D005260:Female; D006301:Health Services Needs and Demand; D006620:Hip Fractures / Q000534:rehabilitation; D006699:Home Care Services / Q000639:trends*; D006801:Humans; D007802:Language; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009788:Occupational Therapy; D009864:Ontario; D026741:Physical Therapy Modalities; D011788:Quality of Life; D000071939:Stroke Rehabilitation
keywords: Geriatrics; multi-level modeling; occupational therapy; physiotherapy