Unmet need and public financing of home care in England

Abstract

AbstractBackgroundPersons living with dementia often wish to remain in their own homes for as long as possible. Given the unpredictable nature and progression of dementia, this means that many adults will require some degree of home‐based support in the initial stages of the disease, as well as requiring continuous, intensive support in the later stages. Public financing can play a central role in ensuring equitable access to home care, however, public financing is limited in many nations due to the high cost of these services. Without consistent government financing, many vulnerable adults may forgo needed care, risking adverse outcomes. In this study, we seek to examine unmet need and the role of public financing of home care among English adults over 50.MethodDrawing on waves 6‐9 (2013‐2019) of the English Longitudinal Study of Ageing, we use longitudinal fixed effects and pooled cross‐sectional models to understand patterns and predictors of unmet need for home care support services. We focus particularly on the type of home care received, differentiating between publicly financed and/or provided care, privately paid formal care, and informal home care services. We also differentiate between unmet need, where no help is received, and ‘under‐met’ need, where help is received but it does not fully meet the needs of the care recipient.ResultWorsening cognition and greater limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) are associated with fewer entirely unmet needs. Receipt of publicly financed and/or provided care is also associated with fewer unmet needs as compared to receiving informal and/or formal privately paid care. However, shifting from publicly financed/provided home care to exclusively informal and/or formal privately paid care is associated with lower odds of under‐met need, where the help provided does not fully meet the home care support needs of the recipient.ConclusionGreater ADL and IADL limitations and worsening cognition may trigger access to home care support services. Public financing/provision of home care may guard against needs going entirely unmet, however, the care that is received may not fully meet the support needs of those with dementia.