Examining Health Service Rates Among Residents of Retirement Homes and Other Older Adult Populations in Ontario, Canada: A Population-Based Cohort Study

Background: There are no standardized reporting systems or assessments specific to residents of retirement homes in North America. As such, little is known about these older adults as a distinct population. We created a new population-level cohort of residents of retirement homes and examined their health service rates relative to other older adult populations. Methods: We conducted a population-based retrospective cohort study in Ontario, Canada in 2018. The postal codes of all licensed retirement homes (n = 757) were classified and linked to individual-level health system administrative data to derive a cohort of residents of retirement homes. A generalized linear model with a gamma distribution and log link function was used to model rates of emergency department visits, hospitalizations, alternate levels of care (ALC) days, primary care visits, and specialist physician visits. Results: Residents of retirement homes comprised two percent of the older adult population in Ontario (n = 54,773; 2.3%). After adjustment for relevant characteristics, residents of retirement homes had 10 times the rate of emergency department visits (Relative Rate [RR] 10.02, 95% Confidence Interval [CI] 9.83 to 10.21), 20 times the rate of hospitalizations (RR 20.43, 95% CI 20.08 to 20.78), and 44 times the rate ALC days (RR 43.91, 95% CI 43.28 to 44.54) compared to community-dwelling older adults. Interpretation: Residents of retirement homes are a distinct older adult population with high rates of hospital-based care. Our findings contribute to policy debates about the provision of health care in privately operated congregate care settings for older adults.