The determinants of the propensity to receive publicly funded home care services for the elderly in Canada: a panel two-stage residual inclusion approach

Abstract

The role of Home Care (HC) services for the elderly will be increasingly important in meeting populations’ future needs for care. HC services include Home Health Care (HHC) and Homemaking/Personal Support (HMPS), distinction rarely seen in the literature. This paper argues that it is important to distinguish between these types of HC, since the factors that drive the likelihood of the receipt of each type of care may differ, and also to investigate the interrelationship between them. We explored the interrelationship between receipt of publicly funded HMPS and HHC, and the determinants of the receipt of each type of services. A Panel Two-Stage Residual Inclusion approach was applied to estimate the likelihood of the receipt of HC services using data for those aged 65 and over from 9 biannual waves of the Canadian National Population Health Survey (1994-95 to 2010-11). We found that there are in fact differences in the determinants of the likelihood of HHC and HMPS receipt. Moreover, receipt of publicly funded HMPS was found to be complementary with receipt of publicly funded HHC services after adjusting for functional and health status. Dependence on help with activities of daily living, health status, household arrangement, and income were found to be determinants of the propensity to receive both publicly funded HHC and HMPS services. This study aims to contribute to the existent literature by taking a step toward explicitly modelling the potential interaction between the determinants of the receipt of different types of HC services simultaneously, as a system. Our methodological approach, a Panel Two-Stage Residual Inclusion method, seems to effectively address problems that are known to be a source of bias in the literature.

The Untold Story of Being Designated an Alternate Level of Care Patient

“…For example, each province has its own unique basket of home care services that vary by type of service available. In addition, while residents in some provinces are subjected to income-testing to assess eligibility for publicly funded home support, those in other provinces may be eligible irrespective of income or assets (Blomqvist and Busby 2012;Mery et al 2014). New Brunswick residents must undergo an income assessment to identify eligibility for publicly funded services and a functional assessment to determine the amount of service.…”

The Effect of Childhood Health Status on Adult Health in China

“…Since all the dependent variables are binary, we used the Two-Stage Residual Inclusion (2SRI) Estimation. The 2SRI estimation has been shown to yield consistent and efficient results, so that it is widely used to solve endogeneity issues in studies where the second-stage dependent variable is binary [ 31 , 38 , 39 , 40 , 41 ].…”

“…The standard errors produced from the nonlinear system using this approach were incorrect, however, as they failed to account for the stochastic nature of the estimated residual terms. Therefore, bootstrapping with 1000 iterations was used to correct the standard errors [ 40 ]. All statistical analyses in the paper were performed using Stata 12 (StataCorp.…”

Living in the Community With Dementia: Who Receives Paid Care?

“…While paid caregivers, including home health aides, personal care attendants, and other direct care workers, may be able to provide additional care (eg, bathing, shopping, and companionship) that keeps those with dementia safe in the community, most existing studies of paid caregivers focus on workforce concerns, including job satisfaction and retention, and fail to consider the impact of paid caregivers on those they care for. Receipt of care from the estimated 2 million paid caregivers providing home care is likely driven not only by functional need but also by socioeconomic characteristics and the caregiving context (eg, living arrangements and number and geographic proximity of children) . Income and Medicaid status likely play important roles in the receipt of paid care; in the United States, paid caregiving in the community is predominantly paid for by individuals and families themselves or Medicaid, whose eligibility and covered services vary significantly by state …”

“…Receipt of care from the estimated 2 million paid caregivers providing home care 9 is likely driven not only by functional need but also by socioeconomic characteristics and the caregiving context (eg, living arrangements and number and geographic proximity of children). 10,11 Income and Medicaid status likely play important roles in the receipt of paid care; in the United States, paid caregiving in the community is predominantly paid for by individuals and families themselves or Medicaid, whose eligibility and covered services vary significantly by state. 12,13 In this study, we used data from the National Health and Aging Trends Study (NHATS), a nationally representative cohort of community-dwelling older adults, to: (a) characterize paid caregiving among community-dwelling individuals with dementia and (b) identify factors associated with receipt of paid care.…”