As the Ontario population ages, the number of older adults with multi-morbidity will rise and many will require long-term care (LTC) supports in the community or residential care settings. To ensure that frail Ontarians receive seamless care across continuing care settings, research evidence is needed to guide health system changes to meet the wishes and complex needs of older adults and their caregivers.
Home and Community Care
Most older adults prefer to stay in their community home when possible. For this to happen, older adults and their families require a range of health and social supports. The QUILT Network looks at what services are available to improve community-dwelling older adults’ quality of life, and see what services are still needed. We also evaluate ways to minimize burdensome transitions and improve client and caregiver experiences. Supports often change over time and may include physician visits, home care services like nursing and personal support worker visits, and management of chronic conditions such as heart failure. Providing appropriate supportive care in the community can prevent unwanted transitions such as hospitalizations and emergency department visits, which are burdensome to clients and caregivers.
Some questions the QUILT Network aims to answer are:
- What health and social services are currently being delivered to older adults in the home and community?
- What are the gaps in home and community care? How can we fill these gaps to improve quality of care for older adults who require long-term supports?
- How do patient characteristics and care trajectories at home and community impact outcomes such as need for a long-term care home, health care use, and patient/caregiver experiences?
Assisted Living and Residential Care
Some older adults choose to leave their private community home and move to a retirement or supportive housing home. These settings provide older adults with a range of support for tasks individuals may no longer be able to do on their own (e.g. medication management, meal preparation, and housekeeping). In fact, the retirement home, supportive housing, and assisted living sectors are the fastest growing sectors in older adult care. Guidelines and regulations in these settings exist, but they are not as well-developed as in the community and long-term care home settings. Further, we do not know the characteristics or preferences of clients in this setting, which makes it difficult to address their health needs and adequately support them.
Some questions we aim to answer are:
- What do the populations in assisted living settings “look like”?
- Can we use existing assessment tools to identify characteristics of older adults associated with transition between retirement homes and supportive housing, or supportive housing and assisted living?
- What policies are in place in assisted living and residential care settings?
Long-term care homes
When older adults are no longer able to safely remain in the community setting, many will move to a long-term care home to receive more extensive care. Clients and caregivers require support navigating the transition from community to a long-term care home, and have to adjust to their new home and care providers once they are in the long-term care home.
In recent years, there has been a sharp increase in the complexity of residents in long-term care homes. Additionally, almost half of long-term care home residents have cognitive impairment. To adequately care for residents with cognitive impairment and complex needs, collaborative and integrated models of care that are person-centered and can be tailored to residents’ needs are required. These models can also improve resident quality of life and decrease burden for informal caregivers and long-term care home staff by minimizing transitions from the long-term care home to acute settings, such as the hospital.
Some questions the QUILT Network aims to answer are:
- How can we make sure evidence-based models of care are implemented across long-term care homes?
- Which older adults are at the highest risk of poor outcomes and transitions (e.g. to the hospital)? How can their risk be minimized?
- How can we make sure long-term care home services are delivered equitably to all residents, including minority populations and residents with dementia?
