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Continuing care workforce : general analysis Rahim-Jamal, Sherin, 1963- Jan 31, 2001

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Centre for Health Servicesand Policy ResearchCONTINUING CARE WORKFORCEGeneral AnalysisSherin Rahim-JamalHHRU 01:1W January 2001Health Human Resources UnitResearch ReportsTHE  UNIVERSITY  OF  BRITISH  COLUMBIACONTINUING CARE WORKFORCEGeneral AnalysisHHRU 01:1WHealth Human Resources Unit Sherin Rahim-JamalCentre for Health Services and Policy ResearchThe University of British ColumbiaVancouver, British Columbia  V6T 1Z3January 2001Prepared by:Health Human Resources UnitCentre for Health Services and Policy ResearchThe University of British Columbia1Continuing Care Workforce - General AnalysisMethodologyI. Identification of Professions Working in Continuing CareDefinition: We assumed several professional sub-groups would be working in the continuingcare field including LPNs, RNs, LGNs, RPNs, Psychologists, OTs, PTs, Health ServiceExecutives (HSE), Social Workers (SWs), and Physicians.  An operationalized definition ofcontinuing care was developed pertaining to those employed in:· Extended Care Hospital· LTC facility/Nursing home· Visiting care agency/Home care· Geriatric Unit Assessment/Discharge· Other health care settings where the main client group is aged 65 years and olderFor each of the professions identified above (with the exception of SWs where we examinedindividual level data gathered by survey for ROLLCALL 95), we examined the ROLLCALL 99data and identified the number of individuals in each profession who had indicated that theyworked in the employment areas outlined above.Limitation: The above information is limited as only published aggregate data (i.e.ROLLCALL 99) are used; we did not examine individual records except for SWs.  Thus, we mayhave missed some people (e.g. some nurses who deliver home care services may have indicatedthat they work in community health, or some nurses working in LTC may be employed byhospitals and not LTC facilities; we would not pick up these people using the above definition).Further verification of area of service requires access to disaggregated unpublished data.It is also important to note that with regard to physicians, we included both general practitioners(GPs) and those who indicated Geriatric Medicine as their specialty.  However, we cannotdetermine from the published data alone the number of GPs who actually work in continuing careand/or who have continuing care patients.  In order to determine this, we would have to examineMSP payment data.The number of GPs and Geriatric Medicine specialists was determined using both the MedicalServices Commission of British Columbia (MSC) specialty codes and the Royal College ofPhysicians and Surgeons of Canada (RCPSC) specialty codes.  However, there was no significantdifference in the number of physicians identified using the MSC codes and the number identifiedusing the RCPSC specialty codes.  As a result, we decided to use the Royal College data forfurther analyses since the RCPSC specialty codes reflect the actual training of physicians ratherthan current practice patterns.II.  Age DistributionAs we did not use individual level data, (except for SWs), to determine the age distribution of theprofessions identified in (I) above as working in continuing care, we assumed that the agePrepared by:Health Human Resources UnitCentre for Health Services and Policy ResearchThe University of British Columbia2distribution for the subset of continuing care staff was the same as the whole membership of aparticular profession.  The age distribution of the membership was then applied to the subsetworking in continuing care.  For example, the subset of LPNs working in continuing care in 1999equalled 1,340 individuals.  Using the proportionate age distribution of the total LPNmembership, we estimated the age distribution of the subset of LPNs working in continuing care:27 of the 1,340 LPNs working in continuing care were aged < 25 years, 178 were 25-34 years,401 were 35-44 years, etc.The limitation here is that the assumption made above about the age profile of the membershipbeing the same as the age profile of those individuals working in continuing care may not becorrect.III.  Ageing of the Continuing Care WorkforceOnce the age profile of each profession working in continuing care was determined, eachprofession was aged 10 years in order to determine the profile 10 years later.  Note that the ageingof each profession was based on the date of record of information provided for ROLLCALL 99.PTs and OTs had a date of record of June 2000 and April 2000 respectively.  As a result, theywere aged 10 years from 2000 to 2010, while the LPNs, RNs, RPNs, and LGNs had a date ofrecord of 1999 and they were aged from 1999 to 2009.  The date of record for SWs is 1996,therefore, the SWs were first aged 3 years to 1999 and then were aged 10 years from 1999 to2009.The limitation here is that since published data are in 10-year age groups, we could only age theindividuals in 10-year segment intervals.IV. RemarksGiven the methodological constraints due to the limitation of published data, it is likely that wehave underestimated the total number of health professionals employed in continuing care.  Also,it is likely that we have overestimated the age of this workforce (i.e. older than they may be); datafrom another study (Nursing Workforce Study Volume II The Supply of Nursing Personnel inCanada and Volume V Changes in the Nursing Workforce and Policy Implications) indicate  thatnew entrants in the RN workforce are employed in LTC.Prepared by:Health Human Resources UnitCentre for Health Services and Policy ResearchThe University of British Columbia3Continuing Care Workforce - General Analysis - ROLLCALL 99Table 1:  Regulated Professions in British Columbia by Place of EmploymentPlace of EmploymentPractising ProfessionalsEmployed in their Respective LTC1 Facility/ Visiting Care Agency/ Geriatric Unit Other Health Total by Place ofProfession Areas of Work Extended Care HospitalNursing Home Home Care Assessment/DischargeCare Settings2 EmploymentLPNs 4,216 581 604 155 1,340RNs 27,992 1,360 2,397 571 4,328LGNs 203 24 138 2 164RPNs 2,179 218 30 248Psychologists (no CCinformation)OTs 854 47 8 19 74PTs 1,937 549 5 70 76 695Health Service Executives(no information on place ofemployment in RC 99)Social Workers3,4 982 66 83 149TOTAL 38,363 2,561 3,501 823 30 83 6,9981 Includes Intermediate Care.2 Includes other health care settings such as Acute Care, Rehabilitation/Vocational, Public/Community Health,   and other.3 Social Work data obtained from ROLLCALL 95. Date of record April 1996.4 Social Workers working in 'Other Health Care Settings' include those whose main client group was indicated as   being aged 65 years and older.5 Includes General/Extended Care Hospital - number in General or Extended Care not specified separately.Prepared by:Health Human Resources UnitCentre for Health Services and Policy ResearchThe University of British Columbia4Continuing Care Workforce - General Analysis - ROLLCALL 99Table 2:  Directory Active Physicians in British Columbia by MSC and RCPSC SpecialtyProfession Directory Active MSC Specialty Group RCPSC Specialty GroupNon-PostgraduatePhysicians GP1 Geriatric Medicine GP1 Geriatric MedicinePhysicians 8,106 4,483 21 4,481 211 Includes General Practice and Family Practice - not able to determine the proportion of GPs that  work with the continuing care population.Prepared by:Health Human Resources UnitCentre for Health Services and Policy ResearchThe University of British Columbia5Continuing Care Workforce - General Analysis - ROLLCALL 99Table 3:  Age Distribution1 of Regulated Health Professionals Working in Continuing Care in B.C.Profession < 25 25 - 34 35 - 44 45 - 54 55 - 64 65 + Age Unknown Total2LPNs 27 178 401 514 192 9 20 1,341RNs 78 734 1,316 1,446 695 59 4,328LGNs3 23 97 39 5 164RPNs 3 38 63 90 46 3 5 248Psychologists4OTs5,6 12 23 15 5 19 74PTs 2 159 215 211 86 15 6 694Health ServiceExecutives7Social Workers 8,9 11 30 43 34 6 25 149Physicians (RCPSC)10 4 730 1,404 1,301 707 347 9 4,5021 The age distribution of respective professions working in Continuing Care has been extrapolated using the  age distribution of those professions in British Columbia as per ROLLCALL 99.2 The total number of individuals in each profession may vary slightly from Table 1 due to extrapolation  and rounding.3 There are no LGNs under the age of 35.4 There is no information on psychologists working in Continuing Care.5 There are no OTs working in Continuing Care under the age of 25 or over the age of 65.6 The number of OTs whose age is unknown has increased substantially since 1995, as the British Columbia   Society of Occupational Therapists (BCSOT) no longer collects birthdate information from its members. 7 There is no age information on Health Service Executives in ROLLCALL 99.8 Social Work data were obtained from survey data collected for ROLLCALL 95. Date of record, April 1996. The    age distribution of SWs has been extrapolated to 1999 using the age distribution for SWs identified as    working in Continuing Care and aging each individual by 3 years from 1996 to 1999. New registrants    since 1996 are not incorporated in these data.9 There are no SWs working in Continuing Care under the age of 25. New registrants since 1996 are not   incorporated in these data.10 Includes both GP and Geriatric Medicine specialties as per the RCPSC specialty codes.Prepared by:Health Human Resources UnitCentre for Health Services and Policy ResearchThe University of British Columbia6Continuing Care Workforce - General Analysis - ROLLCALL 99Table 4:  Regulated Health Professions1,2 Working in Continuing Care in British Columbia, 1999Age at 20093 (Aged 10 years from 1999 - 2009)Profession < 25 25 - 34 35 - 44 45 - 54 55 - 64 65 + TotalLPNs 27 178 401 514 201 1321RNs 78 734 1316 1446 754 4328LGNs 23 97 44 164RPNs 3 38 63 90 49 243OTs4,5 12 23 15 5 55PTs4 2 159 215 211 101 688Social Workers6 11 30 43 40 124Physicians (RCPSC)7 4 730 1404 1301 1054 44931 Psychologists - there is no information in ROLLCALL 99 on psychologists working in Continuing  Care.2 There is no age information on Health Service Executives in ROLLCALL 99.3 Only the cohort working in Continuing Care in 1999 was aged. The numbers provided above do not  take into account new registrants, attritions or reactivations.4 OT and PT information in ROLLCALL 99 had a date of record of April 2000 and June 2000, respectively.5 Note the high number of OTs working in Continuing Care whose age is unknown (26%).6 The date of record for Social Workers is 1996.7 Includes both GPs and Geriatric Medicine specialties as per the RCPSC specialty codes.Prepared by:Health Human Resources UnitCentre for Health Services and Policy ResearchThe University of British Columbia7Figure 1: Regulated Professionals Working in Continuing Care in British Columbia by Age Group, 1999 (%)05101520253035404550556065< 25 25 - 34 35 - 44 45 - 54 55 - 64 65 + AgeUnknownAge GroupPercentLPNsRNsLGNsRPNsOTsPTsSWsPhysicians(RCPSC)Figure 2: Regulated Health Professions Working in Continuing Care in British Columbia in 1999 Aged 10 Years (%)05101520253035404550556065< 25 25 - 34 35 - 44 45 - 54 55 - 64 65 +Age GroupsPercentLPNsRNsLGNsRPNsOTsPTsSocial WorkersPhysicians(RCPSC)

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