Number 52 n April 18, 2012

Characteristics and Use of Home Health Care

by Men and Women Aged 65 and Over

by Adrienne L. Jones, B.S.; Lauren Harris-Kojetin, Ph.D.; and

Roberto Valverde, M.P.H., Division of Health Care Statistics

Abstract

Objective—This report presents national estimates on differences in the use of

home health care between men and women aged 65 years and over.

Methods—Estimates are based on data from the 2007 National Home and

Hospice Care Survey, conducted by the Centers for Disease Control and

Prevention’s National Center for Health Statistics.

Results—In the United States, men aged 65 years and over used home health

care at a lower rate than women. Among home health care patients 65 years and

over, women were more likely to be 85 years and over while men were more likely

to be married and receive home health care as post-acute care. Women 65 years and

over who received home health care were less likely than males to receive wound

care and physical therapy, and more likely to receive homemaker services. Among

home health care patients who were 65 years and over, cancer was more prevalent

among men, and essential hypertension was more common among women.

Keywords: home health care • home and community-based services • caregiving

arrangements • chronic conditions

(2,3). Differences between men and Introduction

women 65 years and over in the use of

Increased life expectancy in recent home health care have been reported in decades has contributed to the aging of previous reports (4–8). In 2007, more the population (1). The aging population than one million men and women 65 as a whole and growth of the very

years and over received home health oldest segments within it are associated

with care each day (9). This report presents the transition from informal to

formal home health care delivery (1). the most recent information available on

Home health care is a formal, regulated the receipt of home health care by men

program of care, providing a range of and women 65 and over and highlights

medical, therapeutic, and nonmedical sex differences in the use of care.

services; delivered by a variety of health

care professionals in the patient’s home

Methods

The data in this report are from the

2007 National Home and Hospice Care

Survey (NHHCS). The 2007 NHHCS is

one in a series of nationally

representative, cross-sectional sample

surveys of U.S. home health and

hospice agencies. It is designed to

provide descriptive information on home

health and hospice care agencies, their

staff members, the services they

provide, and the people they serve.

NHHCS was first conducted in 1992

and was repeated in 1993, 1994, 1996,

1998, 2000, and 2007.

Agencies that provided home health

or hospice care services at the time of

the survey were eligible to participate in

NHHCS. Up to 10 patients were

randomly selected per home health care,

hospice care, or agency that provided

both home health and hospice (mixed

agency). Current home health care

patients were defined as patients who

were on the rolls of the agency as of

midnight of the day immediately before

the agency interview. Further

information on the sampling, survey

design, and other survey methodology is

available in the ‘‘Technical Notes’’ and

documentation provided at: http://

www.cdc.gov/nchs/nhhcs.htm and in

Dwyer et al. (10).

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2	 National Health Statistics Reports n Number 52 n April 18, 2012

Data analysis

The 2007 NHHCS survey sampled

3,226 men and women aged 65 years

and over who received home health

care. Cases with missing data were

excluded from the analyses on a

variable by variable basis. None of the

variables had missing data in excess of

10%. One variable, marital status, has

9% missing; three variables have data

missing between 1% and 3%; all other

variables have less than 1% missing.

Weights that take into account all

sample stages, with adjustments for

nonresponse, were used to produce

national estimates of demographic and

selected health characteristics of men

and women 65 years and over who

received home health care. Differences

between subgroups were evaluated with

two-tailed t test for rates per 1,000

population; and Chi-square tests at the

p=0.05 level for differences in

percentages and percent distributions.

All percentages in Figures 2–5 are

unadjusted. Age-adjusted analyses were

performed using logistic regression for

differences in age distribution in

Figures 2–5; all significant differences

remained after age-adjusted regression

analyses were performed (see

‘‘Technical Notes’’ table). All

comparisons reported in the text are

statistically significant unless otherwise

indicated. Data analyses were performed

using SAS version 9.1 (SAS Institute,

Cary N.C.)(11) and SUDAAN version

9.0 (RTI, Research Triangle Park,

N.C.)(12).

Results

Rate of home health care

use

+	 In the United States, the rate of home

health care use for women aged 65

and over was 55% higher than the

rate for men (Figure 1).

+	 The rate of home health care use

among women aged 65–74 years was

60% higher than the rate for men in

that age group (Figure 1). The rate of

home health care use for women aged

75–84 years was 42% higher than the

rate for men in that age group.

+	 The rate of home health care use

among women aged 85 years and

over was 22% higher than the rate for

men aged 85 years and over but the

difference was not statistically

significant. This lack of significance

may be due to insufficient sample

size.

Age, marital status, and

relationship to primary

caregiver

+	 Female home health care patients

aged 65 years and over were more

likely than male patients to be 85

years and over and were almost three

times as likely to be widowed

(Figure 2).

+	 More than 80% of home health care

patients aged 65 years and over had a

primary caregiver outside of the

home health care agency (males, 85%

and females, 83%) (data not shown).

+	 Male home health care patients aged

65 years and over who had a primary

caregiver outside of the home health

care agency were almost three times

as likely as female patients to have

their spouse as their primary

caregiver; women were about twice

as likely as men to have a child or

other nonspousal family member as

their primary caregiver.

§ Statistically significant difference p < 0.05 by sex. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. Rate per 1,000 population

§20 

31 

§10 

16 

§26 

37 

50 

61 

0 

10 

20 

30 

40 

50 

60 

70 Men Women 

65 years and over 65–74 years 75–84 years 85 years and over

Figure 1. Rate of receipt of home health care per 1,000 civilian noninstitutionalized population aged 65 and over by sex: United States,

2007
Percent

§28 

34 

§65 

26 

§21 

59 

§56 

19 

§29 

66 

0 

10 

20 

30 

40 

50 

60 

70 

Men Women 

85 years and over Married Widowed Spouse or Child or other 

significant other nonspousal 

family member 

§ Statistically significant difference p < 0.05 by sex. Relationship to primary caregiver1
 

1

Includes only patients with a primary caregiver outside of the home health care agency.
 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.
 

National Health Statistics Reports n Number 52 n April 18, 2012	 Page 3

Figure 2. Percentage of men and women aged 65 and over receiving home health care by selected demographic and caregiver

characteristics: United States, 2007

Post-acute care, length of female patients to have had an inpatient + Compared with home health care

service, and payment source stay immediately prior to receiving male patients 65 years and over,

home health care (Figure 3). females were more likely to have

Male home health care patients received home health care for 1 year aged 65 and over were more likely than or more and almost twice as likely to

have Medicaid as their primary

§ Statistically significant difference p < 0.05 by sex. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. Percent 

Men Women 

0 

10 

20 

30 

40 

50 

60 

70 

Medicaid as 

primary payer 

Length of service 

1 year or more 

Had inpatient stay 

immediately prior to 

home health care 

§59 

49 

§14 

20 

§9 

15 

Figure 3. Percentage of men and women aged 65 and over receiving home health care by

selected use and payment characteristics: United States, 2007

source of payment.

Services received

+	 Services commonly used by home

health care patients aged 65 years and

over included skilled nursing services

(84%), physical therapy (40%),

assistance with activities of daily

living (ADLs) (37%), homemaker

services (17%), occupational therapy

(14%), wound care (14%), and

dietary counseling (14%) (‘‘Technical

Notes’’ table).

+	 Sex differences were found for three

of these commonly used services.

Men were more likely to receive

skilled care, including wound care

and physical therapy, whereas women

were almost twice as likely to receive

homemaker services (Figure 4).

Chronic conditions

+ The prevalence of eight common

chronic conditions were examined.
Page 4	 National Health Statistics Reports n Number 52 n April 18, 2012

§ Statistically significant difference p < 0.05 by sex. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. Percent 

Men Women 

0 

10 

20 

30 

40 

50 

Wound care Homemaker services Physical therapy

§18 

12 §11 

19 

§46 

37 

Figure 4. Percentage of men and women aged 65 and over receiving home health care by

selected services: United States, 2007

§ Statistically significant difference p < 0.05 by sex. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007. Percent 

Men Women 

0 

10 

20 

30 

40 

50 

60 

Malignant 

neoplasms 

Osteoarthritis and 

allied disorders, 

except spine 

Essential 

hypertension 

§43 

50 

§8 

15 

§13 

7 

Figure 5. Percentage of men and women aged 65 and over receiving home health care by

selected chronic conditions: United States, 2007

About one-half of home health care pulmonary disease and allied

patients aged 65 and over had conditions; 13% had osteoarthritis

essential hypertension (48%); 39% and allied disorders, except spine;

had heart disease; 32% had diabetes 10% had dementia; 9% had malignant

mellitus; 15% had chronic obstructive neoplasms; and 8% had

cerebrovascular disease (‘‘Technical

Notes’’ table).

+	 Sex differences were found for three

of these eight common chronic

conditions. Among home health care

patients, women were more likely

than men to have hypertension and

were almost twice as likely to have

osteoarthritis, whereas men were

nearly twice as likely to have

malignant neoplasms (Figure 5).

Summary

This report presents national

estimates on differences in the use of

home health care between men and

women aged 65 years and over. Among

adults ages 65–84, women had

significantly higher rates of home health

care use than men. Among home health

care patients 65 years and over, men

were more likely than women to receive

home health care immediately after an

inpatient stay and more likely to receive

services that were associated with

post-acute care such as wound care and

physical therapy. In contrast, women

were more likely than men to receive

homemaker services and to receive

home health care for longer periods of

time. Other gender differences were

shown in relationship to the primary

caregiver and the types of chronic

conditions present. Men aged 65 and

over were more likely to have their

spouse as their primary caregiver;

whereas women were more likely to be

widowed and rely on an adult child or

other nonspousal family member as their

primary caregiver. Women aged 65 and

over were more likely than their male

counterparts to have essential

hypertension and osteoarthritis and

allied conditions and less likely to have

cancer (malignant neoplasms). To

examine whether these differences may

actually be attributed to differences in

the age distributions between men and

women aged 65 and over, age-adjusted

percentages were examined for all

estimates presented (‘‘Technical Notes’’

table). The results of the ageadjustments did not change the original

findings. This suggests that the observed

sex differences were not due to

differences in age distributions between
National Health Statistics Reports

n Number 52n April 18, 2012	 Page5

men and women (i.e., the differences by

sex remained after adjusting for age).

The nationally representative data used

in this report provide greater insight on

the health care needs and use of home

health care services by men and women

aged 65 and over. These findings may

assist health care providers in targeting

specific areas characteristic of the

population aged 65 and over.

References

1.	 Byrne D, et al. Formal home health

care, informal care and family

decision making. International

Economic Review, 50:1205–42.

Doi:10.1111/j.1468–2354.2009.0056.x

2.	 Montauk SL. Home Health Care.

American Family Physician.

Available from: http://www.aafp.org/

afp/981101ap/montauk.html

.

3.	 Murkofsky RL, Alston K. The past,

present, and future of skilled home

health agency care. Clin Geriatr Med

25:1–17. 2009.

4.	 Munson ML. Characteristics of

elderly home health care users: Data

from the 1996 National Home and

Hospice Care Survey. Advance data

from vital and health statistics; no

309. Hyattsville, MD: National

Center for Health Statistics. 1999.

5.	 Dey AN. Characteristics of elderly

home health care users: Data from

the 1994 National Home and Hospice

Care Survey. Advance data from vital

and health statistics; no 279.

Hyattsville, MD: National Center for

Health Statistics. 1996.

6.	 Strahan GW. An overview of home

health and hospice care patients:

1994 National Home and Hospice

Care Survey. Advance data from vital

and health statistics; no 274.

Hyattsville, MD: National Center for

Health Statistics. 1996.

7.	 Dey AN. Characteristics of elderly

home health care users: Data from

the 1993 National Home and Hospice

Care Survey. Advance data from vital

and health statistics; no 272.

Hyattsville, MD: National Center for

Health Statistics. 1996.

8.	 Hing E. Characteristics of elderly

home health patients: Preliminary

data from the 1992 National Home

and Hospice Care Survey. Advance

data from vital and health statistics;

no 247. Hyattsville, MD: National

Center for Health Statistics. 1994.

9. Caffrey C, et al. Home health care

and discharged hospice care patients:

United States, 2000 and 2007.

National health statistics reports; no

38. Hyattsville, MD: National Center

for Health Statistics. 2011.

10. Dwyer LL, Harris-Kojetin LD,

Branden L, Shimizu IM. Redesign

and operation of the National Home

and Hospice Care Survey, 2007.

National Center for Health Statistics.

Vital Health Stat 1(53). 2010.

11. SAS version 9.1 (SAS Institute,

Cary, N.C.)

12. Research Triangle Institute.

SUDAAN (Release 9.0.1). Research

Triangle Park, N.C. 2005.

13. International Classification of

Diseases, Clinical Modification Sixth

Edition. NCHS CD ROM, October

2007 No. 1. DHHS Pub No. (PHS)

07–1260; CS110232 (10/07) T28572.

Available from: http://www.cdc.gov/

nchs/icd/icd9cm.htm.
Page 6 National Health Statistics Reports n Number 52 n April 18, 2012

Technical Notes

Sample design

The 2007 National Home and

Hospice Care Survey (NHHCS) used a

stratified two-stage probability sample

design. The first stage, carried out by

the Centers for Disease Control and

Prevention’s National Center for Health

Statistics (NCHS), was the selection of

home health and hospice agencies from

the sample frame of over 15,000

agencies, representing the universe of

agencies providing home health care and

hospice services in the United States.

The primary sampling strata of agencies

were defined by agency type and

metropolitan statistical area (MSA)

status. Within these sampling strata,

agencies were sorted by census region,

ownership, certification status, state,

county, ZIP Code, and size (number of

employees). For the 2007 NHHCS,

1,545 agencies were sampled with

probability proportional to size. A

detailed methods report on the 2007

NHHCS is available at http://www.

cdc.gov/nchs/data/series/sr_01/

sr01_053.pdf.

The second stage of sample

selection was completed by the

interviewers during the agency

interviews. Current home health patients

were randomly selected by a computer

algorithm, based on a census list

provided by each agency director or his

or her designee. Up to 10 current home

health patients were randomly selected

per home health agency and a

combination of up to 10 current home

health patients and hospice discharges

Table. Unadjusted and adjusted percentages of home health care patients aged 65 and over by selected characteristics, according to 

sex: United States, 2007 

Unadjusted Adjusted

Selected characteristics All Male Female Male Female

Age at interview 

85 years and over .............................................. 32 28 34 ... ... 

Current marital status 

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 §

65 26 §64 26 

Widowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 §

19 50 §19 49 

Primary caregiver status1 

Spouse or significant other ......................................... 31 §56 19 §54 19 

Child (including daughter and son in-law) ................................ 43 §

22 52 §22 53 

Other (nonspousal) family member .................................... 12 §

7 14 §7 14 

Post-acute care 

Yes ....................................................... 52 §

59 49 §58 48 

Length of service (in days) 

1 year or more ................................................ 18 §

14 20 §14 19 

Primary payment source 

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 §

8 14 §8 14 

Services 

Skilled nursing services ........................................... 84 87 83 87 83 

Physical therapy ............................................... 40 §

46 37 §46 37 

Assistance with activities of daily living (ADLs)............................. 37 35 38 35 38 

Wound care .................................................. 14 §

18 12 §18 12 

Dietary counseling .............................................. 14 16 13 16 13 

Occupational therapy ............................................ 14 15 14 15 14 

Homemaker services ............................................ 17 §

11 19 §11 19 

Diagnosis and ICD–9–CM code2 

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(401) 48 §43 50 §43 50 

Heart disease . . . . . . . . . . . . . . . .(391–392.0, 393–398, 402, 404, 410–416, 420–429) 39 42 37 42 37 

Diabetes mellitus ...........................................(250) 32 36 30 35 31 

Chronic obstructive pulmonary disease and allied conditions . . . . . . . . . . . . .(490–496) 15 15 15 14 15 

Osteoarthritis and allied disorders, except spine ........................(715) 13 §

8 15 §8 16 

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(140–208, 230–234) 9 §

13 7 §12 7 

Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(290, 294, 331.0) 10 9 10 10 10 

Cerebrovascular disease .............................(430–435, 437, 438) 8 9 8 9 8 

. . . Not applicable. § Statistically significant difference p<0.05 by sex. 1

Includes only patients with a primary caregiver outside of the home health care agency. 2

Based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM). Up to 16 diagnoses were recorded for each patient at interview. 

SOURCE: CDC/NCHS, National Home and Hospice Care Survey, 2007.
National Health Statistics Reports n Number 52 n April 18, 2012 Page 7

were randomly selected per mixed

agency. Current home health patients

were defined as patients who were on

the rolls of the agency as of midnight of

the day immediately before the agency

interview.

Data collection

Data for the 2007 NHHCS were

collected through personal interviews

with agency directors and staff who

used administrative records to answer

questions about the agencies, staffs,

services, and programs, and medical

records to answer questions about

current patients and discharges. The

agency component of NHHCS

interviews was completed for 1,036

agencies. The first-stage agency

unweighted response rates was 71% and

the weighted by the inverse of the

probability of selection was 59%. The

second-stage patient unweighted

response rate was 95%, and the

weighted response rate was 96% (5). A

detailed description of the sampling

design, data collection, and procedures

are available at: http://www.cdc.gov/

nchs/data/nhhcsd/NHHCS_NHHAS_

web_documentation.pdf.

Estimation

Because the statistics from NHHCS

are based on a sample, they will differ

somewhat from the data that would have

been obtained if a complete census had

been taken using the same definitions,

instructions, and procedures. However,

the probability design of NHHCS

permits the calculation of sampling

errors. The standard error of a statistic is

primarily a measure of sampling

variability that occurs by chance

because only a sample, rather than the

entire population, is surveyed. The

standard error also reflects part of the

variation that arises in the measurement

process but does not include any

systematic bias that may be in the data

or any other nonsampling error. The

chances are about 95 in 100 that an

estimate from the sample differs from

the value that would be obtained from a

complete census by less than twice the

standard error. More information on

estimation is available at: http://www.

cdc.gov/nchs/data/nhhcsd/NHHCS_

NHHAS_web_documentation.pdf.

Definition of terms

Terms relating to home health

care patients

Age—The patient’s age at the time

of the interview. Age is calculated as the

difference in years between the date of

birth and the date of interview.

Chronic conditions—Up to 16

diagnoses were included in the analysis

(1 primary diagnosis and 15 secondary

diagnoses at interview). Diagnoses were

coded according to the International

Classification of Diseases, Ninth

Revision, Clinical Modification (ICD–9–

CM) (13). The data brief focused on the

following conditions: essential

hypertension (401), heart disease

(391–392.0, 393–398, 402, 404,

410–416, 420–429), diabetes mellitus

(250), chronic obstructive pulmonary

disease and allied conditions (490–496),

osteoarthritis and allied disorder, except

spine (715), malignant neoplasms

(140–208, 230–234), dementia (290,

294, 331.0), and cerebrovascular disease

(430–435, 437, 438).

Home health care—Refers to a

range of medical and therapeutic

services as well as other services

delivered at a patient’s home or in a

residential setting for the purpose of

promoting, maintaining, or restoring

health or maximizing the level of

independence, while minimizing the

effects of disability and illness,

including terminal illness.

Home health patient—A patient on

the home health care agency’s roster as

of the night before the interview.

Weighted data represent the total

number of home health care patients

served each day in 2007.

Homemaker services—Includes

assistance in personal care, maintenance

of a safe and healthy environment and

services to enable the individual to carry

out the plan of care.

Post-acute care—Refers to a patient

who was an inpatient in a hospital,

nursing home, or some other kind of

health facility before receiving home

health care.

Primary caregiver—A person who

helps the majority of time in caring for

someone who is ill, disabled, or aged.

Caregivers can be relatives or friends

who volunteer their help; or some

people provide caregiving services for a

cost.

Primary source of payment—The

single payment source that paid the

greatest amount of the patient’s charges

at the time of the interview.

Rate—Refers to the number of

home health care patients aged 65 and

over per unit of population (i.e., per

1,000 civilian noninstitutionalized

persons aged 65 and over). Rates were

calculated using U.S. Census Bureau

2007 based post-censal civilian resident

population estimates.
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National Health Statistics Reports n Number 52 n April 18, 2012

Suggested citation

Jones AL, Harris-Kojetin L, Valverde R.

Characteristics and use of home health care

by men and women aged 65 and over.

National health statistics reports; no. 52.

Hyattsville, MD: National Center for Health

Statistics. 2012.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director 

Jennifer H. Madans, Ph.D., Associate Director 

for Science 

Division of Health Care Statistics

Clarice Brown, MS, Director

For free e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm. 

For questions or general information about NCHS: Tel: 1–800–232–4636 • E-mail: cdcinfo@cdc.gov • Internet: http://www.cdc.gov/nchs 

DHHS Publication No. (PHS) 2012–1250 • CS229986