Who pays for home care? A study of nationally representative data on disabled older Americans

Abstract

BackgroundWe examine who pays for services that support disabled older Americans at home. We consider both personal sources (e.g., out-of-pocket payment, family members) and publicly funded programs (e.g., Medicaid) as sources of payment for services. We examine how the funding mix for home care services is related to older people’s economic resources, needs for care, and other socio-demographic characteristics.MethodsOur sample consists of 11,725 person-years from the 1989, 1994, 1999, and 2004 waves of the National Long-Term Care Survey. Two-part regression analyses were performed to model hours of care received from each payer. “Random effects” and “fixed effects” estimation yielded similar results.ResultsAbout six in ten caregivers (63 %) providing home care services are paid by personal sources alone. By contrast, 28 % receive payment from publicly funded programs alone, and 9 % from a combination of personal and public program sources. Older people with family incomes over 75,000 dollars per year receive 8.5 more hours of home care overall than those in the lowest income category (less than 15,000 dollars). While the funding mix for home care services is strongly related to older people’s economic resources, in all income groups at least 65 % of services are provided by caregivers paid in whole or in part from personal sources. In fact, almost all (97 %) home care received by those with family incomes over 75,000 dollars per year are financed by personal sources alone.ConclusionsWe outline the implications that heavy reliance on personally financed services and economic disparities in overall services use has for disabled older Americans and their families.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0978-x) contains supplementary material, which is available to authorized users.

Fatores associados a não efetivação da alta na assistência domiciliar

“…(18) The association between higher incomes and the odds of receiving at least one hour of HC services was also observed in a survey of 8,815 elderly Americans, being twice as high as that observed in lower-income families. (19) In contrast to these results, a higher probability of HC was reported in poorer classes than in upper class elderly individuals (A and B) in a study with 6,624 elderly individuals from 23 Brazilian states. (13) In another study on the subject, the reason for the association of HC with lower income was related to the reduction of social inequities through the FHS.…”

Whose responsibility? Elder support norms regarding the provision and financing of assistance with daily activities across economically developed countries

“…Therefore, we expect that in countries with greater public social expenditures on formal services people are more likely to prefer publicly financed formal assistance (H1). We also expect that in countries with greater expenditures on cash transfers people are more likely to prefer privately financed formal assistance (H2), because cash transfers increase household income and therefore encourage the purchase of privately financed services (Geerlings et al 2005;Janus and Ermisch 2015;Van Groenou et al 2006).…”

Financial catastrophism inherent with out-of-pocket payments in long term care for households: a latent impoverishment

“…OOP payments also impact on equity [14,15] join to catastrophe and impoverishment although the literature has devoted less attention to these issues. According to Antonanzas and Brías (2013) [16], few studies have been conducted on the effects of OOP on equity and no conclusions have been reached, although, for example, reduced use of prescription drugs in response to higher OOP payments by low-income adults on public assistance have also been reported in Canada [17].…”