The "activities of daily living," or ADLs, are the basic tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring. Reported estimates of the size of the elderly population with ADL disabilities differ substantially across national surveys. Differences in which ADL items are being measured and in what constitutes a disability account for much of the variation. Other likely explanations are differences in sample design, sample size, survey methodology, and age structure of the population to which the sample refers. When essentially equivalent ADL measures are compared, estimates for the community-based population vary by up to 3.1 percentage points; and for the institutionalized population, with the exception of toileting, by no more than 3.2 percentage points. As small as these differences are in absolute terms, they can be large in percent differences across surveys. For example, the National Medical Expenditure Survey estimates that there are 60 percent more elderly people with ADL problems than does the Supplement on Aging.

One of the main barriers to the expansion of paid home care for the chronically disabled is the fear that policymakers have that it will cause friends and relatives to curtail their informal caregiving efforts. Using the first wave of the National L o n g -h Care Survey, we examine whether the amount of paid home care used by disabled elderly persons had a significant influence on the amount of infonnal support they were receiving. Results from a two-stage least squares regression analysis suggest that the amount of i n f d home care received was not significantly affected by the level of formal care. This conclusion held for subgroups of formal care users most likely to exhibit substitution: those without cognitive problems, the disabled elderly with above average income, and persons who lived alone. Even the more severely disabled elderly, who are the target of most proposals to expand paid home care, did not substitute paid care for unpaid. Thus, our study suggests that an increase in paid home care will not erode informal support.Most of the chronically disabled elderly live in the community, not in nursing homes. This is true even among the severely disabled. Family-provided help is the mainstay of home care for the elderly. In 1982, of the 4.65 million older persons in the community who had a chronic disability, roughly 90 percent depended on family and friends to remain at home (Rivlin and Wiener 1988). In the same year, only 25 percent of the chronically disabled elderly reported any paid in-home help, such as home health care, homemaker help, Support for this reseatch was provided by the Health Care Financing Administration, Cooperative Agreement 17-C99376/3-01. Judith Sang1 is the project officer. No official endorsement by either the Health Care Financing Administration or the Department of Health and Human Services is intended or should be i n f d . These opinions are those of the authors and should not be attributed to other staff members, officers, of Pustees of the Broolungs Institution. The authors gratefully acknowledge the research assistance of Robert Simon and the secretarial support of Carolyn Hill and E. Carole Hmgleton. We also gratefully acknowledge comments on an earlier draft from Sheila Murray of the University of Maryland and Kevin Coleman of Lewin/ICl?

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Predictors of elderly nursing home admissions were identified using the 1982-1984 National Long-Term Care Survey. The authors found age and health factors were important predictors. Gender was not a significant predictor for disabled elderly admissions when controlling for other variables, even though women constitute the vast majority of nursing home residents. Three of four measures of informal support availability and use were not significantly related to nursing home admission by the disabled. Income and asset wealth were also nonsignificant predictors of institutionalization by the disabled community population.

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Determinants of paid home care use among the chronically disabled elderly were analyzed using the 1982 National Long-Term Care Survey. In 1982, about one quarter of the elderly disabled had a paid home care provider. Using logistic regression, the analysis found the predictors of any use of paid home care were age, sex, marital status, number of daughters and sons, ADL problems, a prior nursing home stay, an overnight hospital stay, income, home equity, and Medicaid enrollment. Using ordinary least-squares regression, the study also identified predictors of the amount of formal home care used in the last week. For elderly with a paid home care provider, greater age, disability level, not being married, fewer daughters, and cognitive impairment signal significantly more use.

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