Potential informal networks and actual care networks of older adults living outside nursing homes are shown in Table 5. Only 2.5% of those receiving assistance and about 1.2% of those receiving no assistance had no informal network members. The mean size of the potential network is relatively stable across levels of care, approximately 4.0-4.1 across groups.
3+ Self-Care or Mobility Activitiesa | 1-2 Self-Care or Mobility Activitiesa | Household Activitiesb | Any Self-Care, Mobility, or Household Activity | No Self-Care, Mobility, or Household Activityc | |
---|---|---|---|---|---|
Potential informal care network | |||||
Mean | 4.1 | 4.1 | 4.0 | 4.0 | 4.0 |
% with none | 2.7 | 2.9 | 1.9 | 2.5 | 1.2 |
1 | 7.9 | 5.8 | 7.5 | 6.9 | 6.7 |
2 | 13.4 | 16.7 | 15.7 | 15.5 | 12.2 |
3 | 19.6 | 19.5 | 20.4 | 19.8 | 22.2 |
4+ | 56.4 | 55.1 | 54.5 | 55.3 | 57.7 |
Actual networkd | |||||
Mean | 2.6 | 2.1 | 1.8 | 2.2 | 1.1 |
0 | 1.7 | 1.7 | 3.9 | 2.4 | 20.6 |
1 | 24.2 | 35.8 | 39.1 | 33.7 | 53.9 |
2 | 30.1 | 30.3 | 35.9 | 32.1 | 18.9 |
3 | 20.9 | 18.5 | 15.3 | 18.1 | 5.0 |
4+ | 23.2 | 13.8 | 5.8 | 13.7 | 1.7 |
Unweighted n | 749 | 968 | 782 | 2499 | 5110 |
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.)
3+ Self-Care
or Mobility Activitiesa
|
1-2 Self-Care
or Mobility Activitiesa
|
Household Activitiesb | Any Self-Care, Mobility, or Household Activity | |
---|---|---|---|---|
Any paid help | 50.0 | 28.0 | 29.4 | 34.5 |
Any unpaid help | 94.7 | 95.6 | 94.6 | 95.0 |
Paid help only | 5.3 | 4.4 | 5.3 | 5.0 |
Unpaid help only | 50.0 | 72.0 | 70.5 | 65.5 |
Both | 44.7 | 23.6 | 24.1 | 29.5 |
Paid non-staff hours (mean) | 69.9 | 13.7 | 4.5 | 25.9 |
Unpaid hours (mean) | 252.8 | 118.1 | 85.0 | 143.8 |
Total hours (mean) | 322.6 | 131.8 | 89.6 | 169.7 |
Unweighted n | 749 | 968 | 782 | 2499 |
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.
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 |
Potential and Actual Networks and Unmet Need: Supportive Care Settings versus Community. Table 8 shows the size of the potential and actual care networks of individuals receiving assistance with self-care, mobility, and household activities in supportive care settings (other than nursing homes) and community settings. The potential informal care network is slightly smaller in supportive settings than in the community, and a larger percentage of those in supportive care settings have no potential informal caregivers (8.7% vs. 1.3%). Excluding residential care staff, average actual network sizes are similar for those in supportive care settings and the community (1.7 vs. 2.3), but 12.5% of those in supportive care settings have only staff helpers (no non-staff helpers) in their networks.
TABLE 8. Potential and Actual Care Networks for the Non Nursing Home Population Ages 65 and Older Receiving Assistance, by Residential Setting
Supportive Care Settings | Community | |
---|---|---|
Potential informal care network | ||
Mean | 2.9 | 4.2 |
% with none | 8.7 | 1.3 |
1 | 12.4 | 5.9 |
2 | 22.7 | 14.1 |
3 | 20.5 | 19.7 |
4+ | 35.7 | 59.0 |
Actual Networka | ||
Mean | 1.7 | 2.3 |
% with none | 12.5 | 0.5 |
1 | 37.7 | 32.1 |
2 | 31.2 | 33.1 |
3 | 9.9 | 19.9 |
4+ | 8.7 | 14.9 |
Unweighted n | 316 | 2183 |
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 |
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.
Activity | % with Adverse Consequence(N=7609) | % with Adverse Consequence Among Those with Difficulty or Receiving Help with Activity
(N)
|
---|---|---|
Wet or soiled clothes | 3.8 | 43.4 (820) |
Stayed inside | 5.8 | 29.6 (1834) |
Did not go places in home/building | 4.8 | 26.0 (1680) |
Made mistake taking medicine | 3.3 | 19.9 (1482) |
Went without bathing/showering/cleaning | 2.0 | 12.9 (1473) |
Had to stay in bed | 2.3 | 11.5 (1698) |
Went without a hot meal | 1.9 | 9.5 (1844) |
Went without getting dressed | 1.3 | 7.5 (1625) |
Went without groceries | 1.4 | 6.3 (2138) |
Went without paying bills | 0.9 | 5.7 (1549) |
Went without clean laundry | 0.9 | 4.9 (1637) |
Went without eating | 0.3 | 3.7 (671) |
Any consequence | 15.0 | 31.8 (4026) |
SOURCE: 2011 NHATS.
The percentage reporting adverse consequences increases markedly with levels of need (Table 11). Less than 15% of those with difficulty (but not receiving help) with self-care, mobility or household activities and nearly 25% of those receiving help with only household activities reported a consequence. Among those receiving assistance with self-care or mobility, rates were far higher. More than four in ten of those receiving help with 1-2 self-care or mobility activities and about seven in ten of those receiving help with three or more self-care or mobility activities reported at least one consequence in the last month. Adverse consequences were substantially higher among those receiving paid, non-staff help (58.2%) compared with those receiving any unpaid help (44.7%). Estimates for living in supportive care settings indicate only slightly higher rates of unmet than among community residents (35.0% vs. 31.4%).
TABLE 11. Percentage of Older Adults with Difficulty or Receiving Help Who Report an Adverse Consequence Related to Unmet Need: By Level and Type of Assistance
Adverse Consequence with: | |||
---|---|---|---|
Self-Care or Mobility | Household Activities | Either | |
Assistance with any self-care, mobility, or household activity | 38.4 | 16.0 | 44.4 |
3+ Self-care or mobility activitiesa | 71.7 | 18.9 | 73.7 |
1-2 Self-care or mobility activitiesa | 34.8 | 15.7 | 40.7 |
Household activities onlyb | 15.2 | 13.9 | 24.8 |
Difficulty but no help | 7.0 | 9.9 | 14.8 |
Any paid non-staff helpc | 50.3 | 22.7 | 58.2 |
Any unpaid helpc | 38.1 | 16.0 | 44.7 |
Supportive care settings | 28.2 | 11.1 | 35.0 |
Community | 24.6 | 13.6 | 31.4 |
Totalc | 24.9 | 13.4 | 31.8 |
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.
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