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.
Highlights
We examine who pays for services that support disabled older Americans at home
Measures Outcomes Our models examine use of home care services provided by formal caregivers paid by (a) any source, (b) Medicare alone, (c) at least in part by Medicaid, (d) personal sources alone, and (e) both public and personal sources
Personal sources represent the most important funding source for home care services. 63 % of caregivers are paid by personal sources alone and provide 62 % (10.1 h) of the total hours of home care services
Summary
We 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. Home care services (provided by paid caregivers) are a valuable source of post-acute and long-term care for older people and their families. These services may help older people with health problems remain in the community [1], while complementing or serving as a substitute for family caregiving [2]. For these reasons, ensuring equitable access to home care services has been an important goal of long-term care policy, both in the United States and abroad. With few exceptions, studies have not distinguished between home care services by who pays for them and have not examined how publicly funded home care services interface, or combine, with services paid for by various personal sources (see Liu et al [5] and Spector et al [6] for exceptions)
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