Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study

Derek R Manis; Ahmad Rahim; Jeffrey W Poss; Iwona A Bielska; Susan E Bronskill; Jean-Éric Tarride; Julia Abelson; Andrew P Costa

doi:10.1016/j.jamda.2021.07.002

Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study

J Am Med Dir Assoc. 2021 Oct;22(10):2115-2120.e6. doi: 10.1016/j.jamda.2021.07.002. Epub 2021 Aug 2.

Authors

Derek R Manis¹, Ahmad Rahim², Jeffrey W Poss³, Iwona A Bielska⁴, Susan E Bronskill⁵, Jean-Éric Tarride⁶, Julia Abelson⁶, Andrew P Costa⁷

Affiliations

¹ Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada. Electronic address: manisd@mcmaster.ca.
² ICES, Toronto, ON, Canada.
³ School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
⁴ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁵ ICES, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada.
⁶ Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁷ Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, ON, Canada; Schlegel Research Institute for Aging, Waterloo, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 34352202
DOI: 10.1016/j.jamda.2021.07.002

Abstract

Objective: We investigate whether older adults who were newly diagnosed with dementia (severity unspecified) and resided in an assisted living facility that offered a dementia care program had a lower rate of transition to a nursing home, compared to those who resided in an assisted living facility without such a program.

Design: Population-based retrospective cohort study.

Setting and participants: Linked, person-level health system administrative data on older adults who were newly diagnosed with dementia and resided in an assisted living facility in Ontario, Canada, from 2014 to 2019 (n = 977).

Methods: Access to a dementia care program in an assisted living facility (n = 57) was examined. Multivariable Cox proportional hazards regression with robust standard errors clustered on the assisted living facility was used to model the time to transition to a nursing home from the new dementia diagnosis.

Results: There were 11.8 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility with a dementia care program, compared with 20.5 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility without a dementia care program. After adjustment for relevant characteristics at baseline, older adults who resided in an assisted living facility with a dementia care program had a 40% lower rate of transition to a nursing home (hazard ratio 0.60, 95% confidence interval 0.44, 0.81), compared with those in an assisted living facility without such a program at any point during the follow-up period.

Conclusions and implications: The rate of transition to a nursing home was significantly lower among older adults who resided in an assisted living facility that offered a dementia care program. These findings support the expansion of dementia care programs in assisted living facilities.

Keywords: Dementia care; assisted living facilities; long-term care; nursing homes; retirement homes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Assisted Living Facilities*
Cohort Studies
Dementia* / therapy
Humans
Nursing Homes
Ontario
Retrospective Studies