Analysis of Poverty Dynamics in Canada (Working Paper 9)

While we know much about poverty (or “low income”) in Canada in a static context, our understanding of the underlying dynamics remains very limited. This is particularly problematic from a policy perspective and the country has been increasingly left out on an international level in this regard. The contribution of this paper is to report the results of an empirical analysis of low income (“poverty”) dynamics in Canada using the recently available “LAD” tax-based database. The paper first describes the general nature of individuals’ poverty profiles (how many are short-term versus longterm, etc.)., the breakdown of the poor population in any given year amongst these different types, and the characterisation of poverty profiles by sex and family type. It then reports the estimation of various econometric models, starting with a set which specifies entry into and exit from poverty in any given year as a function of a variety of personal attributes and situational characteristics, including family status and changes therein, province of residence, inter-provincial mobility, language, area size of residence and calendar year (to capture trend effects). A set of proper hazard models then adds duration effects to these specifications to see how exit and re-entry probabilities shift with the amount of time spent in a poverty spell or after having exited a previous spell. A final set of specifications then investigates “occurrence dependence” effects by including past poverty spells first in an entry model and then with respect to the probability of being poor in a given year. Policy implications are discussed.

HOME-BASED REHABILITATION AND ITS IMPACT ON HOSPITAL UTILIZATION

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization.