The Connecticut model for financing long-term care: a limited partnership.
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Biomedical subjects
Publications and source records attributed to R J Hanley.
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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 Long-Term Care Survey, we examine whether the amount of paid home care used by disabled elderly persons had a significant influence on the amount of informal support they were receiving. Results from a two-stage least squares regression analysis suggest that the amount of informal 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.
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.
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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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