Long-term care ownership and operator factors in probable delirium: a population-based study from Ontario, Canada

Objectives — To evaluate the association between long-term care (LTC) home ownership models and operator characteristics and the prevalence of probable delirium.

Design — Cross-sectional study using provincial health administrative data.

Setting and participants — All LTC residents aged 65–105 years in Ontario, Canada, who underwent assessment via the Resident Assessment Instrument—Minimum Data Set, version 2.0, between January 1, 2016, and December 31, 2019.

Methods — Probable delirium was identified using the delirium Clinical Assessment Protocol on the Resident Assessment Instrument—Minimum Data Set, version 2.0, assessment. LTC home ownership model (for-profit, not-for-profit, and municipal) and operator characteristics (chain status, operator size, and home size) were evaluated in relation to probable delirium using multivariable logistic regression models.

Results — Among the 169,762 LTC residents included in this study, 94,014 (55.4%) lived in for-profit homes, 42,051 (24.8%) in not-for-profit homes, and 33,697 (19.8%) in municipal homes. Only 3.6% (n = 6182) had probable delirium. The adjusted odds ratios (aOR) of probable delirium in for-profit and municipal homes were 0.83 (95% CI, 0.66–1.06) and 0.89 (95% CI, 0.64–1.25), respectively, compared with not-for-profit homes. Residents in larger homes had a reduced odds of probable delirium (aOR, 0.49; 95% CI, 0.33–0.72 for 50–99 beds; aOR, 0.68, 95% CI, 0.47–0.99 for 100–149 beds, ≥150 beds vs <50 beds). The adjusted odds of probable delirium did not differ across chain status or operator size.

Conclusions and implications — LTC residents in homes with ≥50 beds had reduced odds of probable delirium. This finding may reflect differences in delirium risk or identification across home ownership models. There was no evidence that the prevalence of probable delirium varied across LTC home ownership models, operator size, or chain status.