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Abstract
More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms. To investigate the association between Medicaid home care services and family caregivers' health. This longitudinal cohort study used data from the 1996 to 2017 Medical Expenditures Panel Survey. Data on all household members were collected in 5 interviews over 2 years. Person-level difference-in-difference models were used to isolate within-person changes associated with new onset of Medicaid home care. The Medical Expenditures Panel Survey longitudinal data sets included 331 202 individuals (approximately 10% excluded owing to loss to follow-up). Adult (age ≥21 years) members of households that contained at least 1 person with limited activities of daily living were included in our study. The analysis itself was performed from March to August of 2020. New onset of regular (≥1 time per month) Medicaid home care in the household. Self-rated mental and physical health (planned prior to beginning the study). The study population was 14 013 adults; 7232 were "likely caregivers," or nondisabled adult coresidents of someone with activities of daily living limitations. Overall, 962 likely caregivers were ever exposed to Medicaid home care in the household; for 563, we observed the onset. Of likely caregivers exposed to Medicaid home care, 479 (50%) were women; 296 (31%) were White non-Hispanic, 309 (31%) were Hispanic or Latinx, and 279 (29%) were Black non-Hispanic individuals, respectively; 326 (34%) had less than a high school education; and 300 (31%) were in or near poverty. Median age of participants was 51 (interquartile range, 39-62) years. New-onset Medicaid home care was associated with a 0.08 standard deviation improvement in likely caregivers' self-rated mental health (95% CI, 0.01-0.14; P = .02) measured 1 to 6 months after onset, equivalent to a 3.39% improvement (95% CI, 0.05%-6.33%) over their average preonset mental health. No association with self-rated physical health was found (<0.001 standard deviations; 95% CI, -0.06 to 0.06; P = .99). In this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers.
Highlights
In the US, more than 17 million people care for family or friends who need assistance with activities of daily living.[1]
New-onset Medicaid home care was associated with a 0.08 standard deviation improvement in likely caregivers’ self-rated mental health measured 1 to 6 months after onset, equivalent to a 3.39% improvement over their average preonset mental health
No association with self-rated physical health was found (
Summary
In the US, more than 17 million people care for family or friends who need assistance with activities of daily living.[1] Like most domestic and care labor, this labor is often unpaid, invisible, and performed by women.[2,3,4] When paid, caregiving labor is largely performed by immigrant women and women of color, paid below a living wage, and excluded from labor protections.[5,6,7] Epidemiology, economics, and psychology research shows that uncompensated caregiving is associated with worse physical and mental health, including depression and anxiety[2,8,9,10,11,12,13,14,15,16,17]; elevated cardiometabolic risk factors[11,18,19,20,21]; and higher rates of future cardiovascular disease,[12,18,22,23] frailty,[24] and, according to some studies, death.[25,26,27,28,29,30,31,32] These harms are concentrated among women, people with low incomes, people providing more intensive care, and people without choice in becoming caregivers.[8,18,19,33] caregiving can provide a sense of purpose and connection, in the US, these benefits are typically offset by physical, financial, and emotional strain.[1,11,28,34]
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