Examining the Substitution Effect of Assisted Living Services in Retirement Homes in Ontario, Canada
Bibliographic record
Abstract
Retirement homes provide assisted living services in a residential setting to support independent living. Retirement homes predominately operate on a private, for-profit business model, and these homes are privately financed through out-of-pocket payments by residents and/or their caregivers. This thesis examines whether retirement homes are a substitute congregate care setting to long-term care in Ontario, Canada. The first study created the first population-level cohort of residents of retirement homes with health system administrative data in 2018 and compared the health service rates of residents of retirement homes relative to other older adult populations (i.e., residents of long-term care homes, home care recipients who lived in the community, and community-dwelling older adults). This study found that residents of retirement homes were a unique older adult population with the highest relative rates of hospital-based care. The second study examined the facility-level characteristics of retirement homes that provided a dementia care program in 2018. This study found that these retirement homes offered an array of care services and were fundamentally different from those that did not. The third study investigated whether residents of retirement homes who were newly diagnosed with dementia and resided in a retirement home with a dementia care program had a lower rate of transition to a long-term care home from 2014 to 2019. This study found that residents of retirement homes who had access to a dementia care program in their retirement home had a significantly lower rate of transition to a long-term care home. The findings from these three studies suggest retirement homes may be a substitute congregate care home for a long-term care home in Ontario, Canada. These findings inform health system planning, national dementia care strategies, and policies that address housing, health, and social care needs of older adults.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.005 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".