This qualitative study interviewed case managers in British Columbia, Alberta, Saskatchewan, Ontario and Prince Edward Island to delineate the decision-making process regarding the question of whether clients were cared for at home or placed in residential care and thus to determine ways of bringing about an effective substitution of home care for facility care. Eighty-nine case managers in both rural and urban settings completed questionnaires and participated in focus groups. Through this data collection, almost a dozen “factors” were identified that allowed patients to be cared for at home, including the availability of informal supports, adequate funding and staffing for formal home care services, community support, meal programs, supportive housing, adequate family finances, respite programs, day programs, transportation, and home maintenance. Likewise, a number of factors influenced the decision to place the client in facility care, including the need for transitional, convalescent, or respite care; heavy 24-hour care needs; an unsafe home environment; the presence of incontinence or an inability to transfer; client dissatisfaction with home care services; and the belief that facility care is cheaper.
This project was supported by the Health Transition Fund, which was created in 1997 to provide support for evidence-based decision-making in health care reform by supporting pilot and evaluation projects which test innovative approaches to health care delivery. The views expressed herein do no necessarily represent the official policy of federal, provincial, or territorial governments.