Personal Care Services Utilization by Individuals With Developmental Disabilities

This study examined factors associated with the use of personal care services (PCS) and the amount of authorized hours in California in 2004-2005. Of those Medicaid-eligible individuals with developmental disabilities living at home, 31% received PCS. When we controlled for client need, gender, and age, individuals who were Asian/Pacific Islanders, African Americans, Hispanics, and other races had higher odds of receiving PCS than Whites but were authorized between 16 and 39 hours fewer than Whites. Key Words: developmental disabilities, disparities in access, hours of personal care, personal care services, service utilization. In the United States, about 1 1 million individuals living at home or in the community received assistance with activities of daily living, and of those individuals about 3.1 million needed help with two or more activities of daily living in 2005 (Kaye, LaPlante, & Harrington, 2010). For those who received help, most individuals received informal care provided by family members or friends (90%) and only 1 3% received any paid help in 2005 (Kaye et al.)· Thus, family members provided the majority of help, although there are variations in who provides the informal care by age group (Kaye et al.). Paid personal care services (PCS) are designed to provide assistance with activities of daily living (e.g., bathing, dressing, and eating) and instrumental activities of daily living such as shopping, walking, and preparing meals (Kitchener, Ng, Carrillo, Miller, & Harrington, 2007; Kitchener, Ng, & Harrington, 2004, 2007a, 2007b; Kitchener, Ng, Miller, & Harrington, 2005). These services provide help for individuals with disabilities, including those with developmental disabilities (DDs), to allow individuals to live at home and in the community, and they provide support to families that want to provide services at home (Heller, Miller, & Hsieh, 1 999). They may supplement the informal (unpaid) services provided by family members or may substitute for informal services when these are not available or when individuals live alone and need assistance. Under the Medicaid program, states have the option of offering paid PCS to cover a range of assistance to "accomplish tasks they would normally do for themselves" or to provide assistance to family caregivers (Kitchener et al., 2007a). States are given flexibility in determining the amount, duration, and scope of PCS programs. To be eligible for Medicaid personal care, individuals must meet each state's low incomes and assets requirements as well as the need requirements for receiving services. Braddock et al. (2005) estimated that 44,062 individuals with DD received $701.5 million in PCS in the United States in 2004. Lakin, Prouty, and Coucouvanis (2005) estimated that about 11% of total Medicaid funds spent on DD services were for personal care and home healthcare services. Few studies have examined access to DD services. One recent study of individuals with DDs living at home and in residential settings in California identified predictors of service utilization and expenditures (Harrington & Kang, 2008). The study found that, controlling for client needs, all racial and ethnic minority groups were less likely to receive any DD services and had significantly lower expenditures than Caucasians. Another study found wide variations in eight types of DD service use and expenditures for individuals with DDs living at home and in the community in California (Kang & Harrington, 2008). Controlling for client need, men were more likely to receive out-of-home services, individuals aged 3-21 years were more likely to receive in-home and out-of-home respite services than those over the age of 62 years, and all racial and ethnic minority groups were less likely to receive support and out-of-home services and had lower expenditures than Caucasians. Pruchno and McMullen (2004) examined service utilization patterns by adults with disabilities for dental, vocational training, occupational therapy, psychology, social work, recreation, social activities, and transportation. …