Sarah Funnell1, Jennifer Walker2, Angeline Letendre3, R Lisa Bourque Bearskin4, Douglas Manuel5,6,7,8,9,10,11, Mary Scott9, Sarah Spruin9, Peter Tanuseputro5,6,7,8,9. 1. Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada. sarah.funnell@queensu.ca. 2. Laurentian University, Sudbury, Ontario, Canada. 3. Canadian Indigenous Nurses Association (CINA), Ottawa, Ontario, Canada. 4. School of Nursing, Thompson River University, Kamloops, British Columbia, Canada. 5. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 6. The Ottawa Hospital, Ottawa, Ontario, Canada. 7. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 8. Bruyère Research Institute, Ottawa, Ontario, Canada. 9. ICES, Toronto, Ontario, Canada. 10. Statistics Canada, Ottawa, Ontario, Canada. 11. C.T. Lamont Primary Health Care Research Centre, Ottawa, Ontario, Canada.
Abstract
OBJECTIVES: Most people, including Indigenous people in Ontario, wish to die in their communities. How often Indigenous people in Ontario die in their preferred settings is unknown. This study aims to describe the places of care and death for Indigenous people in Ontario who received provincially funded home care services. METHODS: We conducted a retrospective cohort study using linked health administrative databases housed at ICES. We used a population-based cohort of Indigenous and non-Indigenous people in Ontario who died between April 1, 2010 and March 31, 2015 to describe characteristics of people, places of death, and places of care. RESULTS: Indigenous decedents were on average 8.8 years younger, had more chronic diseases, and lived in lower income neighbourhoods compared with their non-Indigenous counterparts. Indigenous decedents spent nearly 8 more days in acute care in the last year of life and more died in acute care (56.1% versus 46.1%). When controlling for covariates, Indigenous decedents received 1.9 fewer home care nursing hours and 5 fewer personal support worker hours and showed decreased odds (OR 0.72) of receiving a palliative physician visit in the last 90 days of life. Among Indigenous decedents, a palliative physician visit lowered odds of dying in acute care by 50% and total days in acute care by 18%. CONCLUSION: Our study identified a gap in end-of-life care for Indigenous Peoples in Ontario receiving provincially funded home care. Without continued efforts to address challenges that perpetuate health inequalities, we expect many Indigenous people will continue to die in acute care away from their people, families, and culturally relevant supports.
OBJECTIVES: Most people, including Indigenous people in Ontario, wish to die in their communities. How often Indigenous people in Ontario die in their preferred settings is unknown. This study aims to describe the places of care and death for Indigenous people in Ontario who received provincially funded home care services. METHODS: We conducted a retrospective cohort study using linked health administrative databases housed at ICES. We used a population-based cohort of Indigenous and non-Indigenous people in Ontario who died between April 1, 2010 and March 31, 2015 to describe characteristics of people, places of death, and places of care. RESULTS: Indigenous decedents were on average 8.8 years younger, had more chronic diseases, and lived in lower income neighbourhoods compared with their non-Indigenous counterparts. Indigenous decedents spent nearly 8 more days in acute care in the last year of life and more died in acute care (56.1% versus 46.1%). When controlling for covariates, Indigenous decedents received 1.9 fewer home care nursing hours and 5 fewer personal support worker hours and showed decreased odds (OR 0.72) of receiving a palliative physician visit in the last 90 days of life. Among Indigenous decedents, a palliative physician visit lowered odds of dying in acute care by 50% and total days in acute care by 18%. CONCLUSION: Our study identified a gap in end-of-life care for Indigenous Peoples in Ontario receiving provincially funded home care. Without continued efforts to address challenges that perpetuate health inequalities, we expect many Indigenous people will continue to die in acute care away from their people, families, and culturally relevant supports.
Entities:
Keywords:
Health services needs and demand; Health services, Indigenous; Terminal care
Authors: Luke Mondor; Colleen J Maxwell; David B Hogan; Susan E Bronskill; Andrea Gruneir; Natasha E Lane; Walter P Wodchis Journal: PLoS Med Date: 2017-03-07 Impact factor: 11.069