Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Emergency Room Use

07/01/2008

The preceding results, show relatively comparable access to medical care across race/ethnic groups, and between recipients in the IHSS provider groups. However, claims data are not sufficient for determining the quality, timeliness, or appropriateness of this care. Here we separately examine the use of ERs. ERs can serve as alternatives for those without access to physicians or clinics, and/or as an indicator of crisis that may be suggestive of difficulty managing the needs of the personal assistant care recipient.

As seen in Table 22, ER use is a relatively common experience among IHSS recipients of all ages: experienced by more than half of the recipients in each age group. There is some variability among the provider types, with minor children of Parent providers, and adults with Spouse providers having the highest unadjusted rates. Extending this analysis, using the logistic regressions shown in Table 23, the risk adjusted differences among provider groups for recipients age 3-17 become non-significant. Among recipients age 18-64 and those 65 or more, the differences observed in the unadjusted results persist. Spouse providers in both age groups tend to have about 20% higher odds of ER use compared to Non-Relatives. Recipients with Parent providers (non-aged recipients only), in contrast have reduce odds of ER use. Other Relatives in both recipient age groups similarly have lower risk of use. New IHSS recipients, in all age groups similarly have reduced likelihood of ER use.

Looking at race/ethnicity, patterns similar to ACSC hospital use persist with non-Whites (other than Asians) ages 18 and over tending to have higher rates of ER use than Whites. Whether this is in response to problems accessing medical care, or responses to emergent conditions cannot be determined with the available data. As one might expect, this rate increases with more chronic health conditions, and the presence of severe breathing problems.

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