Disability and Care Needs of Older Americans: An Analysis of the 2011 National Health and Aging Trends Study. Care Resources Available to Older Adults with Activity Limitations

 

 

SOURCE: 2011 NHATS; N=7609.

NOTES:

a. Assistance with bathing, dressing, eating, toileting, getting out of bed, getting around inside one’s home or building, or leaving one’s home or building.

b. Assistance related to health or functioning with laundry, hot meals, shopping for personal items, paying bills/banking, handling medications (but not self-care or mobility activities).

c. This group may be receiving paid or unpaid assistance with household and other tasks (e.g., transportation, getting to the doctor, less frequent money management tasks, and choosing health insurance) not necessarily related to health and functioning. Helpers for these tasks are shown in the lower panel under actual network.

d. Actual network in residential care counts only non-staff paid helpers and unpaid helpers. Staff in residential care are excluded from the counts.

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Whereas 75% to more than 80% of all groups have three or more potential informal network members, about two-thirds of all who received assistance rely on only one or two actual caregivers. The size of the actual care network, including paid (non-staff) caregivers, also increases with the level of assistance. For instance, those who receive assistance with only household activities have 1.8 caregivers on average whereas those who received assistance with 3+ self-care or mobility activities have 2.6. (Note that nearly 80% of older adults with no activity limitations also report receiving assistance with household and other activities (for non-health or functioning reasons); persons who fall into this group receive help from on average one person.)

 

The majority of actual helpers to adults receiving assistance with any self-care, mobility, or household activity are members of the potential informal network, typically near relatives (not shown): children in and outside the household (42%), spouses/partners (18%), other household members (8%) and other social network members (6%). The remaining 26% of helpers come from outside the potential network: 10% are paid and 16% unpaid. The most common type of “other” unpaid helpers are friends, followed by granddaughters, other non-relatives, and daughters-in-law.

 

Composition of Actual Network and Hours Received. Table 6 provides information on network composition and hours of non-staff care received by the older population outside of nursing homes, including those in supportive care settings. Among those receiving any help in the last month, 34.5% received paid help (including help from staff), 95.0% received unpaid help, and 29.5% received both types of assistance (Table 6).

 

 

SOURCE: 2011 NHATS; N=2499.

NOTES:

a. Assistance with bathing, dressing, eating, toileting, getting out of bed, getting around inside one’s home or building, or leaving one’s home or building.

b. Assistance related to health or functioning with laundry, hot meals, shopping for personal items, paying bills/banking, handling medications (but not self-care or mobility activities).

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The percentage receiving paid help varies by level of assistance, with those receiving assistance in three or more self-care or mobility activities receiving substantially more paid help than other groups receiving assistance (50.0% vs. 28%-29%). The receipt of unpaid help is nearly universal (94%-96%) across all levels of assistance, but the percentage relying solely on unpaid help is much higher for those receiving assistance only with household activities (70.5%) or 1-2 self-care (72.0%) activities than for those receiving assistance with three or more self-care or mobility activities (50.0%). Correspondingly, the percentage receiving a combination of paid and informal is highest (44.7%) for those at the most intense levels of assistance and is about one in four for other assistance groups.

 

Average paid, unpaid, and total non-staff hours all rise sharply with level of assistance. Older adults receiving assistance with 3+ self-care or mobility activities received an average 323 hours of help provided by non-staff caregivers over the last month: 70 hours of paid care and 253 hours of unpaid care. Older adults receiving assistance with 1-2 self-care or mobility activities received less than half that number of hours--132 hours of care, 14 paid and 118 unpaid, and those adults receiving assistance only with household activities received on average 90 hours of help, nearly all unpaid.

 

In addition to non-staff assistance, those living in settings where supportive services are available (other than nursing homes) received staff-provided help with an array of activities, depending on the place. Table 7 shows the services available (for those in multi-level places, at the current level of care) and used in the last month. The most commonly available services were social activities (92%), meals (87%), and housekeeping services (79%). The services most commonly used by residents were meals (77%) and housekeeping (68%). Although other services were available to the majority of residents, fewer than 50% used transportation, laundry, medication, or personal care services or recreational facilities.

 

Support Services	% with Service Available	% Used Service in the Last Month
Social activities	91.6	61.7
Meals	86.5	76.7
Housekeeping services	79.1	68.0
Van to shopping	75.4	26.0
Van service to the doctor	72.8	27.9
Laundry services	72.3	47.8
Help with medications	64.3	41.6
Recreation facilities	64.0	29.5
Help with bathing or dressing	62.6	30.2

 

SOURCE: 2011 NHATS; N=2499.

NOTE:

a. Actual network in supportive care settings counts only non-staff paid helpers and unpaid helpers. Staff in supportive care settings are excluded from the counts.

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Table 9 shows the distribution of older adults receiving assistance by whether help received is paid or unpaid and mean hours in the last month, by setting.³ The percentage receiving any non-staff paid help is only slightly smaller in supportive care settings than in the community (14.5% vs. 21.2%). The percentage receiving unpaid help is similar: 96.1% in care settings vs. 97.6% in the community. Only about one in ten in supportive care settings vs. nearly one in five in the community receives both paid and unpaid help. Average hours of non-staff paid help in the community are also twice those in supportive care settings (28.7 vs. 14.2 hours) and average unpaid hours are more than three times those in supportive settings (164.0 vs. 49.6 hours).

 

 

	Supportive Care Settings	Community
Any non-staff paid help	14.5	21.2
Any unpaid help	96.1	97.6
Non-staff paid help only	3.9	2.4
Unpaid help only	85.5	78.8
Both	10.6	18.8
Paid non-staff hours (mean)	14.2	28.7
Unpaid hours (mean)	49.6	164.0
Total hours (mean)	63.7	192.6
Unweighted n	283	2174

SOURCE: 2011 NHATS; N=2457.

NOTE:

a. Excludes 42 cases receiving only staff care.

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Overall, 15% of the 65 and older population reported one or more adverse consequences related to unmet need (see Table 10). Focusing on the subset of older adults with care needs (either having difficulty with or receiving help with a self-care, mobility, or household activity), the figure increases to 32%. In other words, one out of every three older adults with basic needs experienced an adverse consequence in the last month linked to unmet need. The most common consequences were wetting or soiling clothes, staying inside, not going places inside one’s home or building, and making mistakes with medicine.

 

SOURCE: 2011 NHATS; N=4026.

NOTES:

a. Assistance with bathing, dressing, eating, toileting, getting out of bed, getting around inside one’s home or building, or leaving one’s home or building.

b. Assistance related to health or functioning with laundry, hot meals, shopping for personal items, paying bills/banking, handling medications (but not self-care or mobility activities).

c. Among those who have received help with self-care or mobility activities or household activities for health-related reasons.

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³ Unlike Table 6, which included staff in the definition of paid help, here we exclude staff in order to highlight paid help from outside the facility.