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

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 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.

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).

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.

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.