Recent innovations in long-term care coverage and financing: a rapid scoping review.

OBJECTIVES: To identify, chart and analyse the literature on recent initiatives to improve long-term care (LTC) coverage, financial protection and financial sustainability for persons aged 60 and older. DESIGN: Rapid scoping review. DATA SOURCES: Four databases and four sources of grey literature were searched for reports published between 2017 and 2022. After using a supervised machine learning tool to rank titles and abstracts, two reviewers independently screened sources against inclusion criteria. ELIGIBILITY CRITERIA: Studies published from 2017-2022 in any language that captured recent LTC initiatives for people aged 60 and older, involved evaluation and directly addressed financing were included. DATA EXTRACTION AND ANALYSIS: Data were extracted using a form designed to answer the review questions and analysed using descriptive qualitative content analysis, with data categorised according to a prespecified framework to capture the outcomes of interest. RESULTS: Of 24 reports, 22 were published in peer-reviewed journals, and two were grey literature sources. Study designs included quasi-experimental study, policy analysis or comparison, qualitative description, comparative case study, cross-sectional study, systematic literature review, economic evaluation and survey. Studies addressed coverage based on the level of disability, income, rural/urban residence, employment and citizenship. Studies also addressed financial protection, including out-of-pocket (OOP) expenditures, copayments and risk of poverty related to costs of care. The reports addressed challenges to financial sustainability such as lack of service coordination and system integration, insufficient economic development and inadequate funding models. CONCLUSIONS: Initiatives where LTC insurance is mandatory and accompanied by commensurate funding are situated to facilitate ageing in place. Efforts to expand population coverage are common across the initiatives, with the potential for wider economic benefits. Initiatives that enable older people to access the services needed while avoiding OOP-induced poverty contribute to improved health and well-being. Preserving health in older people longer may alleviate downstream costs and contribute to financial sustainability.

What is the data-defined length for short time from diagnosis to death that is associated with a low rate of palliative care enrolment for persons with colorectal cancer?

OBJECTIVE: Prior research has demonstrated that people who die shortly after receiving a cancer diagnosis are at increased risk for not being referred to palliative care. No previous studies have empirically derived the length of time between diagnosis and death associated with increased risk. The objective of this study was to identify the length of time between diagnosis and death associated with increased risk for non-enrolment in a palliative care programme. METHODS: Binary recursive partitioning was employed to derive the cut-point for the number of days from colorectal cancer diagnosis to death predictive of a high risk for non-enrolment in a palliative care programme in two health districts in Nova Scotia, Canada. The study included all adults (≥20 years) who were diagnosed with colorectal cancer in the two districts between 1 January 2001 and 31 December 2005 and who died between 1 January 2001 and 31 December 2008 (n=894). RESULTS: Individuals who died within 18.5 days following diagnosis were at highest risk for non-enrolment in palliative care. Of the 60 adults who died in <18.5 days, 16.7% were enrolled in a palliative care programme; of the 835 adults who died ≥18.5 days after diagnosis, 65.9% were enrolled. CONCLUSIONS: This data-driven approach may be used to define the short diagnosis-to-death time frame at which individuals are at increased risk for non-enrolment in palliative care programmes. This approach allows researchers to further investigate and compare empirically-derived cut-points that identify those who die quickly and are at risk of not receiving palliative care.