Unmet need for personal assistance services: estimating the shortfall in hours of help and adverse consequences.

OBJECTIVES Perceived unmet need for personal assistance services (PAS) in activities of daily living (ADLs) and instrumental ADLs and its association with reduced hours of help received and with adverse consequences due to lack of help are examined for adults aged 18 and older using data from the 1994-1997 National Health Interview Survey on Disability. METHODS A two-part multivariate regression model of the probability of PAS use and hours of help received was developed to control for need level, living arrangements, and other characteristics that may differ between persons with met and unmet needs and to determine the shortfall in hours associated with unmet need. RESULTS Individuals with unmet need for personal assistance with two or more of the five basic ADLs have a shortfall of 16.6 hours of help per week compared with those whose needs are met. The relative shortfall is twice as great for persons who live alone as for those who live with others. People who live alone and have unmet needs fare worse than people with unmet needs who live with others, and both groups are more likely than those whose needs are met to experience adverse consequences, including discomfort, weight loss, dehydration, falls, burns, and dissatisfaction with the help received. DISCUSSION Overall, just 6.6% of needed hours are unmet among the 3.3 million people needing help in two or more ADLs. We estimate the annual cost of eliminating unmet need among persons with incomes under 300% of the Supplemental Security Income level between 1.2 and 2.7 billion dollars for those living alone and from 2.2 to 7.1 billion dollars for those living with others.

[1]  M. Laplante,et al.  Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home. , 2002, Health services research.

[2]  S. Katz,et al.  A Measure of Primary Sociobiological Functions , 1976, International journal of health services : planning, administration, evaluation.

[3]  Jonathan Bradshaw,et al.  Taxonomy of social need , 1972 .

[4]  S. Crawford,et al.  A comparison of anlaytic methods for non-random missingness of outcome data. , 1995, Journal of clinical epidemiology.

[5]  K. Manton.  Epidemiological, demographic, and social correlates of disability among the elderly. , 1989, The Milbank quarterly.

[6]  R. Campbell,et al.  State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis. , 2002, Journal of health and social behavior.

[7]  A M Jette,et al.  Functional limitations and disability among elders in the Framingham Study. , 1992, American journal of public health.

[8]  N. Duan.  Smearing Estimate: A Nonparametric Retransformation Method , 1983 .

[9]  W. Manning,et al.  The logged dependent variable, heteroscedasticity, and the retransformation problem. , 1998, Journal of health economics.

[10]  Purvi Sevak,et al.  Use, type, and efficacy of assistance for disability. , 2002, The journals of gerontology. Series B, Psychological sciences and social sciences.

[11]  V Mor,et al.  The prevalence and consequences of unmet need. Contrasts between older and younger adults with disability. , 1997, Medical care.

[12]  C. Morris,et al.  A Comparison of Alternative Models for the Demand for Medical Care , 1983 .

[13]  S. Allen,et al.  Targeting risk for unmet need: not enough help versus no help at all. , 2001, The journals of gerontology. Series B, Psychological sciences and social sciences.

[14]  D. McCaffrey,et al.  Substitution of Formal and Informal Care for the Community-Based Elderly , 1988, Medical care.

[15]  K G Manton,et al.  Changes in home care use by disabled elderly persons: 1982-1994. , 2000, The journals of gerontology. Series B, Psychological sciences and social sciences.

[16]  J. Kennedy,et al.  Unmet and Undermet Need for Activities of Daily Living and Instrumental Activities of Daily Living Assistance Among Adults With Disabilities: Estimates From the 1994 and 1995 Disability Follow-Back Surveys , 2001, Medical care.

[17]  C. Harrington,et al.  State Medicaid Programs Offering Personal Care Services , 2001, Health care financing review.

[18]  P. Kemper.  The use of formal and informal home care by the disabled elderly. , 1992, Health services research.

[19]  E. Proctor,et al.  How much is enough? Perspectives of care recipients and professionals on the sufficiency of in-home care. , 2001, The Gerontologist.

[20]  C. Harrington,et al.  Medicaid 1915(c) Home and Community-Based Services Waivers Across the States , 2000, Health care financing review.

[21]  H. Lentzner,et al.  Unmet need for personal assistance with activities of daily living among older adults. , 2001, The Gerontologist.

[22]  D. Rowland,et al.  Unmet long-term care needs of elderly people in the community: a review of the literature. , 1997, Home health care services quarterly.