Abstract
Objectives
This study compared quality indicators across linguistic groups and sought to determine
whether disparities are influenced by resident-facility language discordance in long-term
care.
Design
Population-based retrospective cohort study using linked databases.
Setting and Participants
Retrospective cohort of newly admitted residents of long-term care facilities in Ontario,
Canada, between 2010 and 2016 (N=47,727). Individual residents' information was obtained
from the Resident Assessment Instrument Minimum Data Set (RAI-MDS) to determine resident's
primary language, clinical characteristics, and health care indicators.
Measures
Main covariates of interest were primary language of the resident and predominant
language of the long-term care facility, which was determined using the French designation
status as defined in the French Language Services Act. Primary outcomes were a set
of quality and safety indicators related to long-term care: worsening of depression,
falls, moderate-severe pain, use of antipsychotic medication, and physical restraints.
Multivariable logistic regression models were used to assess the impact of resident's
primary language, facility language, and resident-facility language discordance on
each quality indicator.
Results
Overall, there were few differences between francophones and anglophones for quality
and safety indicators. Francophones were more likely to report pain (10.9% vs 9.9%;
P = .001) and be physically restrained (7.3% vs 5.2%; P < .001), whereas a greater proportion of anglophones experienced worsening of depressive
symptoms (24.0% vs 22.9%; P = .001). However, quality indicators were generally worse for francophones in Non-Designated
facilities, except for pain, which was more commonly reported by francophones in French-Designated
facilities. Anglophones were more likely to be physically restrained in French-Designated
facilities (6.7% vs 5.1%; P < .001).
Conclusions and Implications
For francophones, quality indicators tended to be worse in the presence of resident-facility
language discordance. However, these findings did not persist after adjusting for
individual- and facility-level characteristics, suggesting that the disparities observed
at the population level cannot be attributed to linguistic factors alone.
Keywords
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Article info
Publication history
Published online: January 09, 2021
Footnotes
Funding sources: This research was supported by a research grant from the Ontario Ministry of Health and Long-term Care (MOHLTC) to the Health System Performance Research Network (HSPRN) and by the MOHLTC Health System Research Fund Program Award for the QUality for Individuals who require Long-Term support (QUILT) Network, grant no. 255. This study was also supported by ICES, which is funded by an annual grant from the Ontario MOHLTC. ICES has been approved by Ontario's Information and Privacy Commissioner since 2005. R.B. is supported by the Institut du Savoir Montfort. ICES collects information most notably for purposes of section 45 of Ontario's Personal Health Information Protection Act (PHIPA). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by MOHLTC is intended or should be inferred. The funders had no influence in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
The authors declare no conflicts of interest.
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