Quality Changes after Implementation of an Episode of Care Model with Strict Criteria for Physical Therapy in Ontario's Long-Term Care Homes

Objectives. To describe the proportion of residents receiving rehabilitation in long-term care (LTC) homes, and scores on activities of daily living (ADL) and falls quality indicators (QIs) before and after change from fee-for-service to an episode of care model; and to evaluate the effect of the change on the QIs.Data Sources. Secondary data were collected from all LTC homes in Ontario, Canada, between January 1, 2011 and March 31, 2015. Variables of interest were the proportion of residents per home receiving physical therapy (FT), and the scores on seven ADL and one falls QI.Study Design. Retrospective, longitudinal study.Data Extraction. All data were extracted from the Resident Assessment Instrument Minimum Data Set.Principal Findings. Fewer residents received PT after the policy change (84.6 percent, 2011; 56.6 percent, 2015). The policy change was associated with improved performance on several ADL QIs. However, having a large proportion of residents receive no PT or little PT was associated with poorer performance on two of the QIs measuring improvement in ADLs [No PT: -0.029 (-0.043 to -0.014); -0.048 (-0.068 to -0.027). PT Conclusions. While controversial, the policy and subsequent PT service delivery change appears to be associated with improved performance on several ADL QIs, except in homes where a large proportion of residents receive no PT and low time-intensive PT.Key Words. Long-term care, nursing homes, physical therapy, occupational therapy, policy
There is significant debate around the best model of funding and delivery of health care services nationally and internationally, including long-term care (LTC). For example, in the late 1990s the [...]