Out-of-pocket expenses related to aging in place for frail older people: a scoping review protocol

Moody, Elaine; Martin-Misener, Ruth; Warner, Grace; Macdonald, Marilyn; Weeks, Lori E.; Shaw, Lynn; McKibbon, Shelley

doi:10.11124/jbisrir-2017-003921

Cited by 3 publications

(1 citation statement)

References 88 publications

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“…Findings from this review, particularly about the direct, private (out-of-pocket) costs of caregiving are consistent with another literature review exploring global out-of-pocket expenditure in the context of aging at home. 44 This study emphasized the importance of developing standardizing approaches to valuating out-of-pocket spending as a percentage of family income for older adults living at home, which informed the focus on home care in our review. Several studies suggest that that home care is not as cost-effective as policymakers had hoped, as the care and cost burden has effectively been transferred from the system to caregivers themselves, thereby increasing societal costs, defined as direct costs and the imputed value of caregivers’ unpaid labor.…”

Section: Discussionmentioning

confidence: 99%

Unpaid Caregiver Costs in Canada: A Systematic Review

Marani

Peckham

2023

Home Health Care Management & Practice

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As utilization of home care increases across Canada, questions are emerging concerning the extent to which home care expenses, many of which are not publicly covered, are borne by unpaid caregivers of home care recipients. In this systematic review, we review English-language literature published between 2001 and 2022 exploring the magnitude and sources of home care costs incurred by unpaid caregivers in Canada. Of particular interest were empirical, cost-of-illness studies that describe the implications of these costs across domains of financial risk, including caregivers’ income level, employment status, and personal health. Following the screening of 492 studies derived across 6 databases (OVID Medline, CINAHL, PsycINFO, AMED, EconLit, and EMBASE), 24 studies were included in this review. Overall, few studies describe how home care expenses incurred by unpaid caregivers contribute to their financial risk. While some studies characterize the direct costs of caregiving incurred by caregivers, including out-of-pocket expenditure on transportation to medical appointments, respite care, home renovations, supplemental housekeeping, and prescription medications, limited studies attempt to estimate the magnitude of these expenses. Concerning financial risk, the literature is chiefly concerned with indirect costs of caregiving, including consequences on caregivers’ employment (foregone wages). Findings from this literature review suggest further work is needed in Canadian context to document costs associated with unpaid home care provision.

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Section: Discussionmentioning

confidence: 99%

Unpaid Caregiver Costs in Canada: A Systematic Review

Marani

Peckham

2023

Home Health Care Management & Practice

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Expanding the Catalog of Patient and Caregiver Out-of-Pocket Costs: A Systematic Literature Review

Schmidt,

Juday,

Patel

et al. 2024

Population Health Management

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Out-of-pocket (OOP) health care expenditures in the United States have increased significantly in the past 5 decades. Most research on OOP costs focuses on expenditures related to insurance and cost-sharing payments or on costs related to specific conditions or settings, and does not capture the full picture of the financial burden on patients and unpaid caregivers. The aim for this systematic literature review was to identify and categorize the multitude of OOP costs to patients and unpaid caregivers, aid in the development of a more comprehensive catalog of OOP costs, and highlight potential gaps in the literature. The authors found that OOP costs are multifarious and underestimated. Across 817 included articles, the authors identified 31 subcategories of OOP costs related to direct medical (eg, insurance premiums), direct nonmedical (eg, transportation), and indirect spending (eg, absenteeism). In addition, 42% of articles studied an expenditure that the authors did not label as “OOP.” A holistic and comprehensive catalog of OOP costs can inform future research, interventions, and policies related to financial barriers to health care in the United States to ensure the full range of costs for patients and unpaid caregivers are acknowledged and addressed.

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Aspects of cognition that impact aging‐in‐place and long‐term care planning

Lindquist

Miller-Winder

Schierer

et al. 2022

J American Geriatrics Society

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Background Older adults frequently defer decisions about their aging‐in‐place/long‐term care (AIP‐LTC) needs. As a result, when older adults experience worsening Alzheimer's disease, family members/friends become surrogate decision makers. We sought to understand what aspects of cognition impact older adult AIP‐LTC planning. Methods As part of the PlanYourLifespan (PYL)‐LitCog study, we longitudinally examined AIP‐LTC decision‐making among a cohort (LitCog) of community‐based older adults (65 years and older) recruited from hospital‐associated primary care clinics in Chicago, Illinois, with extensive cognitive testing. PlanYourLifespan.org (PYL) is an evidence‐based online intervention that facilitates AIP‐LTC planning. Subjects underwent baseline testing, received the PYL online intervention, and then were surveyed at 1, 6, and 12 months about AIP‐LTC decision‐making. Cross‐sectional logistic regression analysis was conducted examining cognitive variables that impacted AIP‐LTC decision‐making. Results Of the 293 older adults interviewed (mean age 73.0 years, 40.4% non‐White), subjects were more likely to have made AIP‐LTC decisions if they had adequate inductive reasoning (ETS letter sets total—OR = 1.14 (95% CI = 1.03–1.27; p < 0.05)) and adequate working memory (size judgment span total—OR = 1.76 (95% CI = 1.13–2.73; p < 0.05)). There were no differences in decision‐making observed in verbal abilities, long‐term memory, or processing speed. All analyses were adjusted for participant gender, race, age, and decision‐making response at baseline. Conclusion Inductive reasoning and working memory are critical to AIP‐LTC decision‐making. Screening routinely for these specific cognitive domains is important in targeting and helping older adults prepare in time for their future AIP‐LTC needs.

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Out-of-pocket expenses related to aging in place for frail older people: a scoping review protocol

Abstract: Production of this report is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government.

Cited by 3 publications

References 88 publications

Unpaid Caregiver Costs in Canada: A Systematic Review

Unpaid Caregiver Costs in Canada: A Systematic Review

Expanding the Catalog of Patient and Caregiver Out-of-Pocket Costs: A Systematic Literature Review

Aspects of cognition that impact aging‐in‐place and long‐term care planning

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