Exploring Home Client Trajectories by Examining Help Received with Personal Support Needs Over Time

Objective: Home care programs help older adults remain in their homes, yet relatively little is known about how clients’ functional needs change over time. This study examined trajectories of functional dependency among home care clients across 2 Canadian jurisdictions. Methods: A retrospective longitudinal cohort design was used with publicly funded home care programs in the Winnipeg Regional Health Authority and Nova Scotia Health. Clients aged 60 years and older who received their first case-managed assessment between 2011 and 2013, had at least 1 reassessment within 4 years, and received at least 6 months of service were included (WRHA n = 5003; NS n = 4640). The slope of monthly service amounts over time at the client level was used to classify cases into worsening, stable, improving, or unstable trajectories. Multinomial logistic regression identified intake characteristics associated with trajectory membership. Results: The most common trajectory was increasing service use (45% WHRA, 46% NS), followed by the stable trajectory group (25% & 30%), decreasing services (20% & 17%), and 10% or fewer of clients followed the less stable pattern. Predictors differed somewhat between WHRA and NS, while recent hospitalization, ADL needs, and a belief that improved independence was possible were associated with declining services/functional improvement. Cognitive impairment or dementia at intake reduced the likelihood of decreasing service use. Conclusions: Home care service use follows diverse pathways rather than a single pattern of decline. These trajectories highlight the heterogeneity among home care populations and provide evidence to inform future predictive models and case management planning.