Out-of-pocket home care expenditures for disabled elderly

Levels and predictors of out-of-pocket home care expenditures for the disabled elderly are examined using a sample of users of home care with out-of-pocket expenditures from the 1984 National Long Term Care Survey (N = 856). Multiple regression results indicate need, specifically functional ability, adds the most explanation to out-of-pocket home care expenditures. Education, marital status, asset availability,density prior nursing home use, and population density, while significant, add relatively little explanation to the total variance. Implications for prevention education and long-term care policy are discussed. Dramatic changes in the age structure of the American population are challenging how we plan, provide, and pay for health care services for individuals over 65 years of age. Longer life expectancy and aging of the "baby boom" cohort and of the population in general suggest the number of elderly with long-term care needs is likely to increase dramatically. The group 85 years and older is growing three to four times faster than the general population and is in particular need of health, social, and personal care services due to physical or mental limitations which hinder independent functioning (American Society on Aging 1988; Rowland and Lyons 1991). It is well documented that most elderly prefer to remain in their own homes for as long as possible (Kane and Kane 1987; Rowland and Lyons 1991). Community-based long-term care is increasingly viewed as the most appropriate alternative to enable an aging population to maintain their independence (Kane and Kane 1987). Paid home care is one means of helping individuals with routine and often repetitive tasks of daily living. Paid home care can range from social services (homemaker/chore, assistance with bathing and toileting) to more health-related services (nursing and nurses aides, monitoring medication). There has been a great deal of research on health care expenditures for acute care (physician or hospital) and institutionalized long-term care (nursing homes), but much less is known about the costs of maintaining elderly in the community through noninstitutionalized care (Feder 1991; Rivlin and Wiener 1988; Soldo 1985). A majority of long-term care expenditure data has focused on skilled care, such as nursing services; few sources of data beyond Medicare and Medicaid records have been available to examine the full range of home care use, sources of financing, or out-of-pocket expenditures. Expenditures on home health care are projected to more than double by the period 2016-2020 (Gravelle and Taylor 1989). Given the many gaps in current public and private programs, when paid home care is utilized the elderly and their family members typically bear the costs (Feder 1991). As home care services become increasingly important, it is essential to learn more about consumer home care expenditures to understand their impact on the family system and to aid in the development of policies on providing and financing of long-term care. This study utilizes a nationally representative sample of noninstitutionalized functionally disabled elderly to gain further understanding of levels and predictors of out-of-pocket expenditures for home care assistance with daily living activities. LITERATURE REVIEW Out-of-Pocket Home Care Expenditures In the only nationally representative study of out-of-pocket home care expenditures Liu, Manton, and Liu (1985) found that noninstitutionalized disabled elderly reported spending an average of $164 per month on out-of-pocket expenditures for both nursing-related help and help with daily living activities. A large proportion (71 percent of adjusted sample) were the only source of payment for helpers suggesting they were buying assistance not normally covered by third-party payers. Of the community living elders using paid help for activities of daily living (not direct nursing care), 11. …