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Introduction
Global patterns of mortality and disease prevalence have shifted significantly from infectious diseases to chronic conditions with chronic diseases accounting for 63 per cent of global mortality in recent years (World Health Organization 2011; Yach et al. 2004). Multiple chronic conditions increase significantly with age and older adults with multiple chronic conditions are frequent users of health care and incur great health-care costs (Fortin et al. 2005; Glynn et al. 2011; König et al. 2013; Lehnert et al. 2011; Ward and Schiller 2013).
This trend is particularly apparent in the primary care setting where the prevalence of adult patients with multi-morbidity is higher than patients with isolated diseases (Fortin et al. 2005; Rizza et al. 2012). With the global share of older people estimated to nearly double by 2050, the challenge of treating older adults with multi-morbidity will increasingly tax health-care systems worldwide (United Nations Department of Economic and Social Affairs, Population Division 2013).
Social support has been shown to improve health outcomes for older adults in several areas including mental health (Kwag et al. 2011), cognitive function (Zhu, Hu and Efird 2012), quality of life (Chan et al. 2005), morbidity (Tomaka, Thompson and Palacios 2006) and mortality (Maier and Klumb 2005). Models of health-service delivery which emphasise and incorporate social support have been shown to decrease health-care expenditures (Shier et al. 2013). More effectively incorporating social support into existing chronic disease service models may decrease health-care costs and improve outcomes for ageing populations. Home and community-based care systems are one such model which provides formal health and social support services (Martin-Matthews, Sims-Gould and Tong 2013; Williams et al. 2009b ). While there are a multitude of definitions of social support, this study approaches social support broadly as 'support', and operationalises it as emotional or instrumental support, including assistance with activities of daily living (ADLs) such as eating and bathing, and with instrumental activities of daily living (IADLs) such as transportation. Furthermore, this study distinguishes between formal (paid) support and informal (unpaid) support, and includes both in this analysis.
Canadian context for home and community care
While all medically necessary care, including physician and hospital care, is assured by the Canada Health Act, receipt of home and community care is not a...