Harold C; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Courtney Harold, M.Sc., Doctoral Candidate, Health Policy and Administration, CB # 7400, School of Public Health, University of North Carolina, Chapel Hill, NC 27516. Tel: 919-929-4968; Fax: 919-966-6961; e-mail: charold@unc.edu
Research Objective: Informal care of the elderly by their children is a common and important alternative to formal care and one that is often preferred by the elderly. Much work has been done to characterize informal caregivers, and to analyze the relationship between informal care and employment. However, there is a dearth of research on how informal care affects formal care of the elderly. The potential for informal care to delay entry into nursing homes or to reduce the demand for home health care may not only improve elderly quality of life but may also have important ramifications for the cost of elderly care. This study will help assess the merit of current proposals to support informal caregivers, such as through a $1,000 tax credit (President Clinton, State of the Union Address, January 19, 1999). I address the following research question: Does informal care of elderly parents by their children delay entry into nursing homes or reduce home health care utilization? Study Design: I use the 1993 and 1995 waves of the Asset and Health Dynamics Among the Oldest-Old (AHEAD) panel survey. The conceptual framework stems from health demand models by Nocera and Zweifel (1996) and Grossman (1972). I use two-part models to predict home health care and nursing home care for the single elderly. Besides children's informal care, I control for elderly health status, health behavior, demographics, and income. Because informal care can both precede and follow a formal care event, simultaneous equations methods must be used to obtain unbiased measures of informal care. I use both full information maximum likelihood (FIML) estimation and more conventional two-stage least squares (2SLS). Population Studied: Single elderly, age 70 and over (N =3,471 in 1993 and N =3,103 in 1995).Principal Findings: At the mean, elderly receiving informal care are 6 percent less likely to use home health care than those who do not, while the frail elderly are 30 percent less likely. Surprisingly, informal care does not affect the number of hours of home health care received for those with positive use. Informal care also does not significantly affect nursing home care. Specification tests show that simultaneity exists between informal and formal care, and that FIML estimation is more appropriate than 2SLS for addressing this simultaneity. Conclusions: Informal care by children is both a substitute for home health care, because it reduces its likelihood of use, and a complement, since it does not reduce the number of hours of home health care. The discovery that informal care does not affect nursing home care warrants more exploration. It is likely that informal care can delay entry into nursing homes, but in this relatively healthy sample of the oldest-old3/4only 3 percent reported nursing home care3/4the true relationship may be obscured. Finally, accounting for simultaneity between informal and formal care is vital to accurately inform the policy process.Implications for Policy, Delivery or Practice: The substitution of informal care for home health care can reduce Medicare expenditures and can help improve elderly quality of life by providing the type of care that the elderly prefer. With the first of the baby boomers nearing retirement in the next decade, the demand for informal care will be larger than ever. However, particularly as more women enter the work force, the supply of informal care is likely to fall. Tax credits for informal caregivers, caregiver training, respite care, and increased workplace flexibility should all be considered as policies to help the supply of informal care meet burgeoning demand. Primary Funding Source: National Institute on Aging.
Publication Types:
Keywords:
- Aged
- Caregivers
- Child
- Data Collection
- Female
- Frail Elderly
- Health Services for the Aged
- Health Status
- Home Care Services
- Homes for the Aged
- Humans
- Infant
- Nursing Homes
- Population
- Respite Care
- hsrmtgs
Other ID:
UI: 102272237
From Meeting Abstracts