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Cited by 38Geriatric Care and Nursing HomesDementia and Cognitive Impairment ResearchCOVID-19 and healthcare impacts

Impact of the COVID-19 pandemic on home care services among community-dwelling adults with dementia

Open access
Jones, Aaron, Maclagan, Laura C., Schumacher, Connie, Wang, Xuesong, Jaakkimainen, R. Liisa, Guan, Jun, Swartz, Richard H., Bronskill, Susan E.·2021·Journal of the American Medical Directors Association
DOI 10.1016/j.jamda.2021.08.031PMC PMC8422852
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Abstract

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. Poisson regression models were fit to compare weekly rates of home care services during the pandemic to historical trends with rate ratios (RRs) and 95% confidence intervals (CIs) stratified by service type (nursing, personal care, therapy), sex, rurality, and neighborhood 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), whereas 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, whereas 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.

AI snapshot

Written from the paper’s full text.

TL;DR

In Ontario, Canada, publicly funded home care for community-dwelling adults with dementia was disrupted during the first COVID-19 wave, with personal care and therapies falling sharply while nursing was largely maintained. Service rates generally recovered by September 2020, though rural residents had a larger personal care decline and a smaller nursing rebound.

Key findings

  • At the lowest pandemic week, personal care visits fell 16% versus 2019 (RR 0.84, 95% CI 0.84, 0.85), therapies fell 50% (RR 0.50, 95% CI 0.48, 0.52), and nursing did not significantly decline (RR 1.02, 95% CI 1.00, 1.04).
  • By the latest week analyzed (September 20, 2020), personal care had recovered to 2019 levels (RR 0.99, 95% CI 0.99, 1.00), while nursing was 14% higher (RR 1.14, 95% CI 1.11, 1.16) and therapies were higher (RR 1.11, 95% CI 1.07, 1.15).
  • Rural residents experienced a larger initial personal care decline (RR 0.77, 95% CI 0.75, 0.79) than urban residents (RR 0.84, 95% CI 0.84, 0.85) and no nursing increase by September 2020 (RR 0.99, 95% CI 0.92, 1.07).
  • The highest income quintile had a larger initial personal care decline (RR 0.79, 95% CI 0.78, 0.81), but changes were otherwise largely consistent across sex, rurality, and income strata.

Methods

  • Population-based time series analysis of community-dwelling adults with dementia in Ontario, Canada, aged 40 years and older, using weekly eligibility from January–September 2019 and 2020; there were 131,466 such adults in the first week of March 2020.
  • Linked health administrative databases (Ontario Registered Persons Database and Home Care Database) measured publicly funded home care visits for personal care, nursing, and therapies.
  • Poisson regression models with year as the sole independent variable compared weekly 2020 rates with corresponding 2019 weeks, overall and stratified by service type, sex, rurality, and neighborhood income quintile; rate ratios were reported at the lowest 2020 week and the latest week.

Limitations

  • The authors state that data capture all publicly funded home care in Ontario but not privately paid home care.
  • The authors state they lack information on the specific reasons why home care services were canceled or delayed.
  • The authors state the study did not include a comparison group of older adults without dementia; the observational time series design also cannot establish causality, and findings may not generalize beyond Ontario’s publicly funded home care context (evident from the text).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jamda.2021.08.031

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    By the end of September 2020, the weekly rate of nursing visits for community-dwelling adults with dementia in Ontario was 14% higher than in 2019 (RR 1.14, 95% CI 1.11, 1.16).

    “By the end of September 2020, the rate of nursing visits was 14% higher than 2019 (RR 1.14, 95% CI 1.11, 1.16).”
    Quote in the paperSubstantial claim
  • Findingown data

    During the first wave of the COVID-19 pandemic, the weekly rate of therapies for community-dwelling adults with dementia in Ontario at its lowest point in 2020 was 50% lower than the corresponding week in 2019 (RR 0.50, 95% CI 0.48, 0.52).

    “therapies fell by 50% (RR 0.50, 95% CI 0.48, 0.52)”
    • Also stated in: § Results · plain
      “The rate of therapies declined dramatically through March and April 2020, reaching half of the level of 2019 (RR 0.50, 95% CI 0.48, 0.52).”
    Quote in the paperSubstantial claim
  • Findingown data

    By the end of September 2020, the weekly rate of personal care visits for community-dwelling adults with dementia in Ontario had recovered to the 2019 level (RR 0.99, 95% CI 0.99, 1.00).

    “By the end of September, the rate had recovered to the 2019 level (RR 0.99, 95% CI 0.99, 1.00) (Table 2 ).”
    Quote in the paperSubstantial claim
  • Findingown data

    During the first wave of the COVID-19 pandemic, the decline in personal care visits was larger in rural areas than in urban areas among community-dwelling adults with dementia in Ontario (RR 0.77 vs 0.84).

    “although the rural population experienced a larger decline in personal care”
    • Also stated in: § Results · plain
      “Individuals in rural areas experienced a slightly larger decline (RR 0.77, 95% CI 0.75, 0.79, vs urban 0.84, 95% CI 0.84, 0.85) but similar recovery.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Changes in home care service rates during the COVID-19 pandemic were largely consistent across strata defined by sex, rurality, and neighborhood income quintile among community-dwelling adults with dementia in Ontario.

    “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.”
    • Also stated in: § Discussion · plain
      “The disruptions were largely similar across strata defined by rurality, sex, and neighborhood income quintile”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim. 2
  • May combine two claims. 9
  • Classified as probably not a substantial claim. 5

  • The quote only partly states this claim.

    Findingown data

    During the first wave of the COVID-19 pandemic, individuals with dementia in Ontario living in the highest neighborhood income quintile experienced a larger initial decline in personal care visits than the overall population.

    “Those living in areas with the highest income (Q5) also experience larger initial declines.”
    • Also stated in: § Discussion · plain
      “individuals in the highest income quintile experienced a larger initial decline in personal care.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    By the end of September 2020, the rebound in nursing visits was smaller in rural areas than in urban areas among community-dwelling adults with dementia in Ontario (RR 0.99 vs 1.15).

    “smaller rebound in nursing”
    • Also stated in: § Results · plain
      “However, the rural population did not experience an increase in nursing visits in 2020 vs 2019 (RR 0.99, 95% CI 0.92, 1.07).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Early in the COVID-19 pandemic, home care workers faced unsafe working conditions because of a lack of personal protective equipment and infection control guidance, which may have led to cancelation of service.

    “In addition, early in the pandemic, home care workers faced unsafe working conditions because of a lack of personal protective equipment and infection control guidance, which also may have led to cancelation of service.22 , 23”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [22] Rowe T.A. Patel M. O’Conor R. COVID-19 exposures and infection control among home care agencies Arch Gerontol Geriatr 91 2020 104214 32768800 PMC7390796

      Not checked in the free run.

    • cites [23] Sterling M.R. Tseng E. Poon A. Experiences of home health care workers in New York City during the coronavirus disease 2019 pandemic: A qualitative analysis JAMA Intern Med 180 2020 1453 1459 32749450 PMC7404061

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Individuals receiving nursing and therapies tend to be younger, have fewer functional and cognitive impairments, and more likely to be post-acute compared with patients receiving personal support.

    “Previous work indicates that individuals receiving nursing and therapies tend to be younger, have fewer functional and cognitive impairments, and more likely to be post-acute compared with patients receiving personal support.15”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Jones A. Schumacher C. Bronskill S.E. The association between home care visits and same-day emergency department use: A case–crossover study CMAJ 190 2018 E525 E531 29712671 PMC5929891 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Eligibility for the study was determined on a week-by-week basis, meaning that participants were not a fixed cohort but could vary over time.

    “Eligibility was determined on a week-by-week basis, meaning that the participants were not a fixed cohort but could vary over time.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The larger initial decrease in personal care among residents of the wealthiest areas may be related to having additional options or resources to secure necessary care.

    “Residents in the wealthiest areas also had a larger initial decrease in personal care, which may be related to having additional options or resources to secure the necessary care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Public home care services for community-dwelling adults with dementia in Ontario were interrupted during the first few months of the COVID-19 pandemic (March and April 2020) but recovered through the summer and regained or exceeded historical levels by the end of September 2020.

    “Public home care services provided to community-dwelling adults living with dementia were interrupted during the first few months of the COVID-19 pandemic (March and April 2020) but recovered through the summer months and regained or exceeded historical levels by the end of September 2020.”
    • Also stated in: § Conclusions and Implications · plain
      “Although nursing care was largely uninterrupted during the COVID-19 pandemic, personal care and therapies declined dramatically during the early months, although service levels recovered by the end of September 2020.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Sex, rurality, and neighborhood income quintile have been previously tied to inequalities in access to care that could be exacerbated by the COVID-19 pandemic.

    “Sex, rurality, and income quintile were chosen as strata as they have been previously tied to inequalities in access to care that could be exacerbated by the pandemic.13 , 14”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Sourial N. Arsenault-Lapierre G. Margo-Dermer E. Sex differences in the management of persons with dementia following a subnational primary care policy intervention Int J Equity Health 19 2020 175 33023582 PMC7539425 source

      Not checked in the free run.

    • cites [14] Bainbridge D. Seow H. Sussman J. Factors associated with not receiving homecare, end-of-life homecare, or early homecare referral among cancer decedents: A population-based cohort study Health Policy 119 2015 831 839 25497714 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Nursing may have been considered more essential than personal care or therapies during the COVID-19 pandemic based on provincial guidelines that prioritized reducing direct impacts on safety and minimizing harms, explaining the observed differences in service disruption.

    “Thus, nursing may have been considered more essential than personal care or therapies based on provincial guidelines that prioritized reducing direct impacts on safety and minimizing harms,20 explaining the differences we observed in our study.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Chief Medical Officer of Health Directive #2 for health care providers (regulated health professionals or persons who operate a group practice of regulated health professionals). Toronto, Canada Available at: https://www.crpo.ca/wp-content/uploads/2020/03/CMOH-Directive-2-RHPA-professionals-2020-03-19.pdf

      Not checked in the free run.

    • Rests on an assumption: Home nursing provides necessary care that would otherwise need to be received in other ambulatory care settings.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study does not have information on the specific reasons why home care services were canceled or delayed.

    “Also, we do not have information on the specific reasons why home care services were canceled or delayed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Equitable access to home care in rural areas has been previously identified as a challenge.

    “Equitable access to home care in rural areas has been previously identified as a challenge”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Forbes D.A. Edge D.S. Canadian home care policy and practice in rural and remote settings: Challenges and solutions J Agromed 14 2009 119 124 19437267

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The degree of disruption to home care services during the COVID-19 pandemic varied by service type: nursing declined only slightly, personal care declined moderately, and therapies declined more.

    “The degree of disruption varied by service type, with nursing declining only slightly, personal care declining by a moderate degree, and therapies declining by a larger degree.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The data sources capture all publicly funded home care services in Ontario but do not have data on home care paid for privately.

    “Our data sources capture all publicly funded home care services in Ontario, but we do not have data on home care that is paid for privately.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Increasing caregiver burden has been observed during the COVID-19 pandemic and linked to rising rates of distress and burnout.

    “Increasing caregiver burden has been observed during the pandemic and linked to rising rates of distress and burnout.24 , 25”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [24] Budnick A. Hering C. Eggert S. Informal caregivers during the COVID-19 pandemic perceive additional burden: Findings from an ad-hoc survey in Germany BMC Health Serv Res 21 2021 353 33863337 PMC8050992

      Not checked in the free run.

    • cites [25] Cohen S.A. Kunicki Z.J. Drohan M.M. Exploring changes in caregiver burden and caregiving intensity due to COVID-19 Gerontol Geriatr Med 7 2021 Feb 26 2333721421999279. [Epub ahead of print] PMC7919204 33718523

      Not checked in the free run.

14 of 14

  • The paper relies on this without support.

    Any interruption to home care places additional burden on individuals with dementia and their caregivers.

    “Regardless of the cause, any interruption to home care places additional burden on individuals with dementia and their caregivers.”

  • The paper relies on this without support.

    Personal care services, if not provided by a home care worker, would need to be provided by an unpaid caregiver.

    “Personal care services assist an individual in the activities such as dressing, toileting, and transferring and if not provided by a home care worker would need to be provided by an unpaid caregiver.”

  • The paper relies on this without support.

    Loss of personal care can impact the safety of those needing care, increasing the risk of falls and injury.

    “Although it may not be considered as essential as nursing, the loss of personal care can impact the safety of those needing care, increasing the risk of falls and injury.”

  • The paper relies on this without support.

    Loss of home care services may increase social isolation among individuals with dementia.

    “Additionally, loss of services may increase social isolation”

  • The paper relies on this without support.

    Home nursing provides necessary care that would otherwise need to be received in other ambulatory care settings.

    “Home nursing in particular provides necessary care that would otherwise need to be received in other ambulatory care settings.”

  • The paper relies on this without support.

    Home care services are a critical or essential component of the support system for adults with dementia in the community.

    “Home care services are a critical component of the support system for adults with dementia in the community.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Home care services rebounded to historical highs.

    “Personal care and therapies for persons with dementia were significantly interrupted, although, home care services rebounded to historical highs [8,34].”

    From Towards defining quality in home care for persons living with dementia (2022) · cites this paper as [8]

  • Personal care and therapies for persons with dementia were significantly interrupted during the early phase of the pandemic.

    “Personal care and therapies for persons with dementia were significantly interrupted, although, home care services rebounded to historical highs [8,34].”

    From Towards defining quality in home care for persons living with dementia (2022) · cites this paper as [8]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting confidence interval for the lowest personal-care rate

    Minor

    The Results text gives an upper 95% confidence limit of 0.95, whereas the abstract and Table 1 give 0.85 for the same overall rate ratio of 0.84.

1 of 1

The citation lists haven’t been fetched yet

References 19 · Cited by 38

Authors
Jones, A., Maclagan, L. C., Schumacher, C., Wang, X., Jaakkimainen, R. L., Guan, J., Swartz, R. H., & Bronskill, S. E.
Affiliations
  • Institute for Clinical Evaluative Sciences (CA)
  • Brock University (CA)
  • Sunnybrook Health Science Centre (CA)
Corresponding author
Jones, Aaron
ORCID
Venue
Journal of the American Medical Directors Association
Publisher
Elsevier BV
Published
2021-11
Volume
22
Issue
11
Pages
2258-2262.e1
ISSN
1525-8610 (ISSN-L)
DOI
10.1016/j.jamda.2021.08.031
PMC
PMC8422852
OpenAlex
W3197834485
Semantic Scholar
3084177a310fe142a4c1416d5cd2f769898a5275
Cited by
38
References
19
Citations by year
2026: 5 · 2025: 9 · 2024: 8 · 2023: 6 · 2022: 9 · 2021: 1
FWCI
6.74
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Medical Directors Association (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Ontario Brain Institute
  • Alzheimer Society of Canada
Topics
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
Keywords
COVID-19 pandemic, home care, dementia, community-dwelling adults, personal care, nursing care, therapeutic services, urban-rural differences, neighborhood income, sociodemographic disparities, Ontario
MeSH terms
COVID-19, SARS-CoV-2, Adult, Dementia, Home Care Services, Humans, Ontario, Independent Living, Pandemics

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