Impact of the COVID-19 pandemic on home care services among community-dwelling adults with dementia
Jones A, Maclagan LC, Schumacher C, Wang X, Jaakkimainen RL, Guan J, Swartz RH, Bronskill SE. J Am Med Dir Assoc. 2021; 22(11):2258-62.e1. Epub 2021 Sep 6. DOI: https://doi.org/10.1016/j.jamda.2021.08.031
Objective — To examine how the COVID-19 pandemic impacted use of home care services for individuals with dementia across service types and sociodemographic strata.
Design — Population-based time series analysis
Setting and Participants — Community-dwelling adults with dementia in Ontario, Canada from January 2019 to September 2020
Methods — We used health administrative databases (Ontario Registered Persons Database and Home Care Database) to measure home care services used by participants. Possion regression models were fit to compare weekly rates of home care services during the pandemic to historical trends with rate ratios (RR) and 95% confidence intervals (CI) stratified by service type (Nursing, personal care, therapy), sex, rurality, and neighbourhood income quintile.
Results — During the first wave of the pandemic, personal care fell by 16% compared to historical levels (RR 0.84, 95% CI (0.84,0.85)) and therapies fell by 50% (RR 0.50, 95% CI (0.48, 0.52)), while nursing did not significantly decline (RR 1.02, 95% CI (1.00, 1.04)). All rates had recovered by September 2020, with nursing and therapies higher than historical levels. Changes in services were largely consistent across sociodemographic strata, although the rural population experienced a larger decline in personal care and smaller rebound in nursing.
Conclusions and Implications — Personal care and therapies for individuals with dementia were interrupted during the early months of the pandemic, while nursing was only minimally impacted. Pandemic responses with the potential to disrupt home care for individuals living with dementia must balance the impacts on individuals with dementia, caregivers, and providers.
View full text