These notes support the interactive web-based tool profiling seniors in continuing care. Specific values in these tools may vary from those found in Quick Stats for the Home Care Reporting System (HCRS) and Continuing Care Reporting System (CCRS) due to methodological differences. Small cell counts have been suppressed in accordance with CIHI’s privacy and confidentiality policy. Data series are displayed in the interactive tools only where 3 or more years of data are available.

Data sources

  • Canadian Institute for Health Information
    • HCRS, 2011–2012 to 2015–2016
    • CCRS, 2011–2012 to 2015–2016

Inclusions and exclusions

Inclusions

  • Age at assessment between 65 and 115 years
  • Non-initial HCRS records and residential care type CCRS records (i.e., not including CCRS hospital-based continuing care)

Exclusions

  • Encrypted Health Care Numbers (HCNs) in one of the standard linkage exclusion files (e.g., invalid, children sharing with their mother, other HCNs identified as used by more than one person)
  • Health Card Province Code missing or invalid
  • CCRS episodes or assessments with a data quality flag indicating a concern, or those identified as either a transfer between facilities or a discharge

The profile population is defined by 3 care settings:

Home care: Individuals with a non-initial interRAI Resident Assessment Instrument–Home Care (RAI-HC) © assessment in HCRS in the fiscal year

Residential care intake: Individuals with an interRAI Resident Assessment Instrument–Minimum Data Set (RAI-MDS 2.0) © admission assessment in CCRS in the fiscal year

Residential care reside: Individuals with a RAI-MDS 2.0 non-admission assessment in CCRS in the fiscal year

In cases where individuals have more than one assessment of a specific type, the data shows information from the last assessment of each type in the fiscal year. Individuals may appear in more than one of these care settings in a fiscal year.

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Scales and selected measures

Functional status

The Activities of Daily Living (ADL) Self-Performance Hierarchy Scale reflects the resident’s self-performance in 4 key activities of daily living: personal hygiene, toileting, locomotion and eating. The scale ranges from 0 to 6. Higher scores indicate a greater need for assistance with ADLs. The values indicated for extensive physical assistance represent those with an ADL score greater than 2.

The Changes in Health, End-Stage Disease and Signs and Symptoms (CHESS) Scale is designed to predict mortality associated with frailty and to measure instability in health. This scale ranges from 0 to 5. Each upward increment in the scale represents an increased risk of mortality, more intense service use and increased health instability. The values indicated for moderate to high health instability represent those with a CHESS score greater than 2.

The Cognitive Performance Scale (CPS) summarizes the client’s cognitive status based on assessment items relating to short-term memory, ability to make daily decisions, expressive communication and late-loss ADL (eating). The CPS score ranges from 0 to 6. The values indicated for moderate to severe cognitive impairment represent those with a CPS score greater than 2.

The Depression Rating Scale (DRS) is a scale intended to screen for depression among residents of continuing care facilities. It uses 7 symptoms related to verbal and non-verbal indicators of depression and anxiety. DRS scores range from 0 to 14, with a score of 3 or greater indicating the potential presence of a depressive disorder. The values indicated for depressive symptoms or depression represent those with a DRS greater than 2.

Behavioural symptoms

The Aggressive Behaviour Scale (ABS) summarizes information on 4 behavioural symptoms captured in the RAI-MDS 2.0 that may be considered aggressive: verbal abuse, physical abuse, socially inappropriate or disruptive behaviour and resistance to care. A resident’s ABS score is based on the number and frequency of these behaviours documented in the 7 days prior to the assessment. It ranges from 0 to 12, with a higher score indicating a higher degree of aggressive behaviour. The values indicated for signs of aggressive behaviour represent those with an ABS greater than 0.

Responsive behaviours reflect a number of behaviours determined to be either aggressive or disruptive, including verbal and physical abuse, resisting care and socially inappropriate or disruptive behaviour. A change in behaviours reflects situations where these behaviours may have increased in frequency or become more challenging to manage. Change in behaviours may also reflect a change in wandering behaviours. Change in behaviours is measured only on the RAI-HC.

Characteristics

Caregiver distress reflects situations where the primary caregiver has indicated that he or she is distressed, angry, depressed or in conflict because of caring for the client. Caregiver distress is measured only on the RAI-HC.

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Populations of interest

Seniors meeting the following criteria were included in our populations of interest. For the physical needs and low–moderate needs populations of interest, proxies were developed to match the selection criteria across the RAI-HC and RAI-MDS 2.0 instruments.

Lighter care needs

At least borderline cognitively intact (CPS 0–1)
At most, supervision required in daily tasks (ADL 0–1)
Low health instability or better (CHESS 0–2)
No wandering

Physical needs

Not independent in daily tasks (ADL >0)
No responsive behaviours (i.e., no verbal and/or physical abuse, not disruptive and/or resisting care)
No more than mild cognitive impairment (CPS 0–2)
No challenges with eating (i.e., more than one meal per day/no more than 25% of food uneaten at most meals, no swallowing problems or feeding tube required)
No falls

Low–moderate needs

Not independent in daily tasks (ADL >0)
No responsive behaviours (i.e., no verbal and/or physical abuse, not disruptive and/or resisting care)
No more than mild cognitive impairment (CPS 0–2)
No challenges with eating (i.e., more than one meal per day/no more than 25% of food uneaten at most meals, no swallowing problems or feeding tube required)
No falls OR
Independent in daily tasks (ADL = 0)
At least borderline cognitively intact (CPS 0–1)
No responsive behaviours (i.e., no verbal and/or physical abuse, not disruptive and/or resisting care)
No pressure or stasis ulcers stage 3 or above

Dementia and light care needs

Alzheimer’s or other dementia
At most, limited assistance required in daily tasks (ADL 0–2)
No more than mild cognitive impairment (CPS 0–2)
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