Health status and needs of Aboriginal people assessed for home care in Ontario
Doctor of Philosophy
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The health disparities experienced by Aboriginal populations in Canada have been an important topic for provincial and national health care. In general, the health status and resource utilization of Aboriginal groups have been lower than that of the Canadian population. Recently, an assessment tool called the Resident Assessment Instrument (RAI) was mandated for use in home care settings. This dissertation examined the health status (as measured by the RAI) of Aboriginal and non-Aboriginal clients assessed for home care in Ontario by analyzing client demographics, health status indicators, and summary scale scores. Sequential multilevel linear modeling analyzed the summary scale scores with respect to ancestry, sex, age, and socio-economic status; regional differences in outcome scores were observed. Aboriginal ancestry had a significant effect on depression, cognitive status, and activities of daily living scores when control variables were not considered. Once age, sex, and socio-economic status were accounted for, Aboriginal ancestry did not have an effect on these outcome measures. Aboriginal ancestry did have a significant effect on pain scores. Qualitative data obtained through key informant interviews identified several challenges to providing home care to Aboriginal peoples, including language, infrequent access to services in rural areas, and client transience. These findings support the recognition of individual demographic as well as regional factors as contributors to disease prevalence within the home care population. Further validation of the RAI-HC and development of an Aboriginal RAI tool would increase the utility of the RAI with Aboriginal clients and provide a higher quality of data with which to direct policy and funding.