title: Dementia care in Ontario, Canada: evidence of more timely diagnosis among persons with dementia receiving care at home compared with residential facilities.
abstract: OBJECTIVE
  Home care (HC) has been promoted as an efficient alternative to residential care (RC). However, little is known about the individuals who receive HC. This study compared the cognitive and functional statuses of persons with dementia receiving HC or RC at the time of diagnosis with dementia. It was hypothesized that persons with dementia receiving RC would have declined further, both cognitively and functionally.
  
  
  METHODS
  Population-based secondary data analysis.
  
  
  METHODS
  Data from the Canadian Institute for Health Information's Continuing Care Reporting System and the Home Care Reporting System, 2009-2011, were used. Respective populations of 39,604 and 21,153 persons with dementia who received either RC or HC were included. Cognitive and functional statuses were measured using a cognitive performance scale (CPS) and an activities of daily living (ADL) scale, respectively.
  
  
  RESULTS
  The mean CPS score was higher for the RC group (3.2 vs 2.5). The proportion of individuals diagnosed when impairment was moderate to very severe (CPS ≥ 4) was higher in the RC group (32.0% vs 13.3%). The mean ADL score was also higher for the RC group (3.5 vs 1.6). The proportion of individuals diagnosed when they required extensive assistance or were totally dependent (ADL ≥ 3) was markedly higher in the RC group (72.3% vs 27.3%). All findings were statistically significant (P < 0.0001). Multivariable analysis suggested that RC clients were nearly four times more likely than HC clients to be diagnosed at a later stage (odds ratio = 3.74, 95% confidence interval 3.54-3.95).
  
  
  CONCLUSIONS
  Persons with dementia in RC facilities in Ontario are diagnosed when their cognitive and functional statuses have declined more than those of their HC counterparts.
authors.affiliation: Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada. Electronic address: emma.bartfay@uoit.ca.
authors.forename: Emma
authors.initials: E
authors.lastname: Bartfay
authors.affiliation: Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
authors.forename: Wally J
authors.initials: WJ
authors.lastname: Bartfay
authors.affiliation: School of Social Work, University of Windsor, Windsor, Ontario, Canada.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Gorey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003704:Dementia / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D009864:Ontario; D012112:Residential Facilities
keywords: Activities of daily living; Cognitive status; Dementia diagnosis; Functional status; Home care; Residential care