Disability and home care dynamics among older unmarried Americans.
OBJECTIVE
We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines.


METHODS
Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models.


RESULTS
Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care.


CONCLUSIONS
Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities.
Freedman
Vicki A
VA
Polisher Research Institute, Abramson Center for Jewish Life (formerly Philadelphia Geriatric Center), Horsham, North Wales, Pennsylvania 19454, USA. vfreedman@abramsoncenter.org
Aykan
Hakan
H
Wolf
Douglas A
DA
Marcotte
John E
JE
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017533:Marital Status; D011446:Prospective Studies; D012847:Single Person / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States