Eligibility for publicly financed home care

Estimating the Size of the Adult Population Needing Personal Assistance Services

Legislative initiatives to expand federal funding of personal assistance services (PAS) have relied primarily or exclusively on need for assistance with activities of daily living (ADLs). Analyses of the U.S. Census Bureau's 1990 and 1991 Survey of Income and Program Participation (SIPP) indicate that roughly 1.4 million Americans report needing assistance with three or more ADLs, and that 35% of these are under age 65. Only a small subset of the population needing assistance with three or more ADLs (22%) also report family incomes at or below the federal poverty level, suggesting that means-testing could significantly reduce the size of the population eligible for a federal benefit. Different ADL, age, and income criteria substantially affect the size and composition of the eligible population. The policy implications and limitations of these findings are discussed.

Effects of Improved Morbidity Rates on Active Life Expectancy and Eligibility for Long-Term Care Services

This study examines effects of better health on active life expectancy and eligibility for long-term care services, using data from the 1984-1990 Longitudinal Study of Aging and microsimulation techniques. Results show that better health increases total life expectancy (TLE), the proportion of life spent unimpaired, and the amount of time spent unimpaired. Women experience larger proportional increases in active life expectancy under assumptions of better health. Better health also reduces the proportion of men and women who would be eligible for long-term care services. However, better health decreases the proportion of men eligible for long-term care services more than it decreases the eligible proportion of women. The results reinforce the importance of focusing on policies designed to promote healthy lifestyles and to reduce the prevalence of chronic conditions.

Setting eligibility criteria for a care-coordination benefit

OBJECTIVES

To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served.

DESIGN

Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older.

SETTING

Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey.

PARTICIPANTS

Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries).

MEASUREMENTS

Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency.

RESULTS

A small portion of Medicare beneficiaries (1.3-5.8%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population.

CONCLUSION

Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults.

Older people's willingness to use home care nursing services

AIM

This paper reports a study exploring willingness to use home care nursing services among older people and discussing the implications for long-term and home care nursing policies.

BACKGROUND

The proportion of older people is increasing in all societies across the world. Correspondingly, Korean society has experienced a rapid growth in its population of older people, and this is expected to increase from 7.2% in 2000 to 14.4% in 2019. The government is in the process of developing publicly-financed long-term care for older people, and home care nursing services are expected to be provided as an element of this care. Methods. A cross-sectional study design was used, employing data from a nationally representative interview survey with 1834 respondents conducted during May and July, 2001. Univariate and logistic regression analyses were conducted.

RESULTS

Willingness to use home care nursing services differed according to whether co-payment was required. About half the respondents answered that they would not use the services; 43% expressed a willingness to use them without co-payment; and 5% were very willing to use them even with co-payment. People with lower incomes showed greater willingness to use the services with no co-payment, while the high income group showed the greatest willingness under co-payment. Sex, living with adult children, living area, activities of daily living, and chronic conditions were associated with willingness. Older people who had known about or used home care nursing services previously showed greater willingness.

CONCLUSIONS

Co-payment guidelines for minimizing unmet needs are required, especially for older people with low incomes. A positive evaluation from those who knew about or had used such services is expected to contribute to the use of home care nursing services by older people.

A comparative analysis of disability measures and their relation to home health care use

This study examines the relationship between various definitions of disability and the use of home health care. Using data from the 1993 Survey of Asset and Health Dynamics among the Oldest Old, four measures of disability are constructed based on the concepts of difficulty and assistance. Logistic regression techniques are used to examine differences across measures in the probability of home health care use for specific subgroups of the older population (e.g., married Black females, unmarried White males). Home health care use was most likely when the presence of both assistance and difficulty were included in the definition of disability. Regardless of the measure used, women, Whites, and unmarried people had higher likelihoods of using home health care than men, Blacks, and married people respectively. If used as a service eligibility criterion, an inclusive measure of disability would result in a large number of potential service users. Efforts to control expenditures through the use of a narrower measure that requires the presence of assistance may disadvantage some subgroups of the older population.

A screening system for Michigan's home- and community-based long-term care programs

PURPOSE

To develop a screening system for Michigan's MI Choice publicly funded home- and community-based services programs, to aid in identifying both individuals eligible for services and their most appropriate level of care (LOC).

DESIGN AND METHODS

Identify assessment items from the Minimum Data Set for Home Care (MDS-HC) assessment instrument that are predictive of five LOCs determined by expert care managers: nursing home, home care, intermittent personal care, homemaker, and information and referral (without services).

RESULTS

The algorithm based on approximately 30 client characteristics agrees with expert opinions substantially better (kappa =.62) than systems based on activities of daily living and instrumental activities of daily living only (kappa <.40).

IMPLICATIONS

The screening algorithm can be used both over the telephone to identify clients who will not be fully assessed (as they are unlikely to receive services) and in person to recommend the appropriate LOC.

Difficulty or dependency? Effects of measurement scales on disability prevalence among older Americans

This study examines how the prevalence of disability among subgroups of older persons is influenced by the activity of daily living (ADL) scale selected. Using the 1993 Survey of Asset and Income Dynamics of the Oldest Old, we construct four disability scales, ranging from difficulty performing an ADL to receiving help with an ADL, or dependency. In all instances, the difficulty scales produce substantially higher estimates of disability than the dependency scales. Larger percentages of women, Blacks, and less educated persons are classified disabled under all scales compared with men, Whites, and more educated persons. Specific subgroups are more sensitive to the scale used. The policy implications of using ADL scales to establish program eligibility are discussed.

Care arrangement decisions for frail older women: quantitative and qualitative perspectives

This study uses both quantitative and qualitative methods to investigate how a range of care arrangement decisions for frail older unmarried women are made. Quantitative data from the 1989 National Long-Term Care Survey provides information concerning factors that predict the probability of five categories of care arrangements, including self only care, nursing home care, informal only care, formal only care, and a mix of formal and informal care. Qualitative interview data provides information on what occurs during care arrangement decision-making processes. Results are combined to explain the choice of care arrangements for a small sample of chronically disabled older unmarried women. Results show that need factors, such as age and disability, are strong predictors of the need for assistance. Family members played a central role in determining care arrangements and often helped an older woman to avoid an unwanted care arrangement. The use of a broad measure of impairment resulted in high levels of disability for the sample participants. Both disability status and care arrangements were transitory in nature.

Predictors of dietary intake in a functionally dependent elderly population in the community

OBJECTIVES

The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people.

METHODS

All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses.

RESULTS

Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision.

CONCLUSIONS

Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.