Abstract
Objectives
Immigrants often face many unique cultural and logistical challenges in their health
care that differ from nonimmigrants. We sought to describe and compare characteristics
and the time to placement between recent immigrants and long-standing residents waiting
for long-term care (LTC).
Design
Population-based retrospective cohort study using linked health administrative data.
Setting/Participants
We examined all Ontario residents aged 65 years or older who were placed on the LTC
waitlist between January 2007 and December 2010. We defined recent immigrants as those
granted permanent residency or citizenship status in Canada after 1985; all others
were defined as long-standing residents.
Methods
The primary outcome was the number of days on the waitlist before LTC entry, indexed
on the incident waitlist record, with a maximum follow-up until December 2012. A generalized
estimating equation model was used to identify factors associated with the number
of days spent waiting for LTC entry.
Results
We identified 56,031 individuals on the LTC waitlist, among whom 3.0% were recent
immigrants. Compared with long-standing residents, recent immigrants were younger
(age ≥80: 66.6% vs. 72.7%), from lower income neighborhoods (bottom 2 brackets: 50.0%
vs. 44.0%), and had fewer comorbidities (≥5: 41.6% vs. 36.5%). A larger proportion
of caregivers of recent immigrants reported being unable to continue providing care
(21.6% vs. 16.7%) and expressed greater feelings of distress (26.9% vs. 20.7%). The
median wait time to LTC placement was 165 days for immigrants versus 126 days for
long-standing residents. Applying to a cultural/ethnic-specific home [Arithmetic Mean
Ratio (AMR) = 1.32, 95% Confidence Interval (CI) 1.11–1.56] and being an immigrant
(AMR = 1.22, 95% CI 1.15–1.30) was associated with significantly longer wait times
to placement, adjusting for covariates.
Conclusions/Implications
Recent immigrants vary considerably from long-standing residents, and tend to wait
longer to be placed into LTC homes. Future research is necessary to understand how
we can reduce wait times to LTC entry for the aging population, with a particular
focus on immigrants who are often highly disadvantaged.
Keywords
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Article info
Publication history
Published online: September 20, 2020
Footnotes
The authors declare no conflicts of interest.
This work was supported by a research grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC) to the Ontario QUILT (QUality for Individuals who require Long-Term support) Network (Grant ID no. 255). This work was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.
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