Measuring the Elderly's need for home care

Abstract

Prologue: Among the nation's thirty-one million people age sixty-five and over, nearly four million live at home, despite physical limitations that make it difficult to carry out activities of everyday life. Most of these elderly people live in the community, with family and friends or on their own. As the nation's elderly population continues to grow, an emerging federal funding priority revolves around financing long-term home care for impaired elderly people. While Medicare pays for the medical care these people receive in institutions, a gap remains in funding for home care. Increasingly, policymakers and payers are using the activities of daily living (ADL) scale developed by Sidney Katz in the 1960s to measure elderly people's ability to function—and thus their eligibility for home assistance. Impairment in these activities—eating, dressing, bathing, transferring from bed to chair, and using the toilet—can be strongly predictive of an elderly person's need to receive assistance. This article by Diane Rowland profiles the population of elderly most likely to benefit from a home care proposal such as the one put forward by the late Rep, Claude Pepper (D-FL). Rowland, who received her doctorate in health policy and management from The Johns Hopkins School of Hygiene and Public Health, is an assistant professor in that institution's Department of Health Policy and Management, She is associate director of The Commonwealth Fund Commission On Elderly People Living Alone, an $8 million initiative that since 1985 has been addressing the unique needs of this elderly population. The commission's May 1989 report, Help at Home: Long-Term Care Assistance for Impaired Elderly People, proposes a modest expansion of Medicare benefits to provide home care services for the two million most severely impaired elderly, which would help alleviate the burden placed on these elderly and those who care for them.