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The CCHS-HA, conducted from December 2008 through November 2009, covered the household population aged 45 or older in the ten provinces. Full-time members of the Canadian Forces and residents of Indian reserves and some remote areas were excluded. The response rate was 74.4%.

The sample for this analysis numbered 16,369 respondents aged 65 or older, weighted to represent a population of approximately 4.4 million in 2009. Weighted frequencies and cross-tabulations were used to estimate the percentages of people who had received home care and/or had unmet needs for professional care. Covariates were selected based on the literature and/or data availability. To account for survey design effects, standard errors and coefficients of variation were estimated using the bootstrap technique.12,13 Results at the p < 0.05 were considered to be statistically significant. Details about the survey design and sampling techniques have been published elsewhere.14

Receipt of home care was derived from questions on formal and informal care. For formal care, respondents were asked, "During the past 12 months, did you receive short-term or long-term professional assistance at home, because of a health condition or limitation that affects your daily life, for any of the following activities?" (Professional assistance referred to both paid and unpaid workers.)

  • Personal care such as assistance with eating, dressing, bathing, or toileting
  • Medical care such as help taking medicine or help with nursing care (for example, dressing changes or foot care)
  • Managing care such as making appointments
  • Help with activities such as housework, home maintenance or outdoor work
  • Transportation, including trips to the doctor or for shopping
  • Meal preparation or delivery
  • Other
  • None

Respondents could select all that applied. For informal care, the question was repeated, but referred to "family, friends, or neighbours" instead of professionals. Home care recipients were those who reported having received at least one type of home care from formal and/or informal sources.

Unmet professional home care needswere identified by asking respondents, "During the past 12 months, was there ever a time when you felt that you needed professional home care services but you didn't receive them?" The same list of activities as the formal/informal home care questions was read to respondents. Respondents could give up to 15 reasons why they believed they had unmet homecare needs. These reasons were collapsed into three categories: health care system features (including availability and wait times), personal barriers (including inability to pay, ineligibility and lack of awareness), and both.

Socio-demographic variables included in the analysis were: sex, age, province of residence, social assistance, and living arrangements. Respondents were divided into three age groups: 65 to 74, 75 to 84, and 85 or older. Respondents were considered to be lower income if they cited Old Age Security, Guaranteed Income Supplement, or provincial/municipal social assistance or welfare as their main income source. For living arrangements, respondents were classified as living alone or with others.

Perceived tangible support was measured with four questions: "How often is each of the following kinds of support available to you if you need it: Someone to:

  • help you if you were confined to bed?"
  • take you to the doctor if you needed it?"
  • prepare your meals if you were unable to do it yourself?"
  • help with daily chores if you were sick?"

Respondents who reported "none of the time" or "a little of the time" to one or more of these questions were considered to be lacking tangible support.

The Health Utility Index (HUI) was used to define disability level. HUI considers eight dimensions of health: vision, hearing, speech, emotion, mobility, dexterity, cognition, and pain and discomfort. Each dimension has five or six levels, ranging from normal to severely limited functioning. HUI values range from -0.36 (the worst possible health state) to 1.0 (optimal health state), and were recoded to represent three disability levels: no or mild disability (0.89 to 1.00), moderate disability (0.70 to 0.88), and severe disability (less than 0.70).15

Respondents were considered to have a severe personal care limitation if they were "totally unable" to eat, dress, or bathe/take care of their appearance. Those who needed "some help" were considered to have some personal care limitation.

Respondents reporting that they were completely unable to walk were considered to have a severe mobility limitation; those who could walk with some help from a person and/or with mobility aids were considered to have some mobility limitation.

The CCHS-HA did not collect information about the frequency, intensity or duration of home care, and it is not possible to distinguish between government-funded and privately funded home care. Data on unmet home care needs reflect respondents' perceptions; no external validation was performed. Home care data from the CCHS-HA are not directly comparable to estimates based on CCHS 2.1 or 3.1 or the General Social Survey data, because of differences in question wording and/or ordering. It is thought that the CCHS-HA estimates are higher because the other surveys ask respondents if they had received home care before asking what types and from whom. This practice seems to disproportionately affect the reporting of informal care; without the more detailed prompting of the CCHS-HA, respondents tend to overlook much of the care provided by family and friends. While 13% of CCHS-HA respondents reported receiving home care exclusively from informal sources, the figure was 4% for CCHS 3.1 respondents (data not shown). The differences in the order of interview questions did not affect the reporting of formal and mixed home care to the same extent. Despite these survey/reporting differences, the relationships between socio-demographic and health status characteristics generally persisted, regardless of the dataset used.