A multi-state transition model among older adults receiving home care services: a population-based cohort study

BACKGROUND: Older adults with loss of autonomy often face multiple care transitions, some of which can be burdensome. While home care services (HCS) aim to support aging in place, little is known about the transition patterns over time. METHODS: This is a retrospective cohort study, using health administrative data from Quebec (Canada), focusing on older adults receiving HCS. Continuous-time multi-state Markov models estimated transition probabilities across five states: home, hospital, waiting at home for long-term care (LTC) placement, LTC, and death. Covariates included sex, age, residence type, and comorbidities. RESULTS: Among the 3424 HCS recipients, males were younger and had more comorbidities. The probability of transitioning directly from home to hospital increased for people with chronic conditions but was reduced for those with dementia. These people had an increased risk of getting on a waiting list for LTC placement or directly moving to LTC facilities. HCS were lower in intensity, and with fewer services provided by healthcare professionals, for patients waiting at home for LTC placement. CONCLUSIONS: The study reveals gaps in HCS delivery, particularly for those awaiting LTC placement. Multi-state modeling provides valuable insights into care transitions and can inform targeted improvements in service planning for older adults with complex needs.