Nav: Home

Study shows a rising, but uneven, tide of in-home care for disabled seniors

July 12, 2016

ANN ARBOR, Mich. - More seniors are getting help from family, friends and hired helpers to keep them in their homes, despite disabilities that keep them from total independence, a new study finds.

But that increase isn't happening evenly across all groups. And the rising demand may have implications for the lives and careers of caregivers, and for policies that aim to support at-home caregivers.

In the new issue of JAMA, a University of Michigan Medical School team reports that 50 percent of disabled seniors had some form of in-home help in 2012. That's up nearly 20 percent, or 8 percentage points, since the start of the study in 1998.

The sharpest rise was among those who had milder disabilities -- suggesting that these seniors may have been trying to avoid entering a nursing home and instead "age in place."

The study included nearly 5,200 people 55 or older who lived at home and had at least one disabling condition, and took part in the Health and Retirement Study, a long-term study run by the U-M Institute for Social Research. Each was interviewed at home or by telephone several times over the course of the study.

"Caregiving is essential for keeping people at home and out of nursing homes. But we were surprised by the size of the increase from 1998 to 2012," says Claire Ankuda, M.D., M.P.H., the study's lead author and a Robert Wood Johnson Clinical Scholar at U-M's Institute for Healthcare Policy and Innovation. "As we see more of an emphasis by seniors on staying in their homes, and valuing their independence, and as the size of the senior population grows, we need to be thinking as a society about potential ways to help caregivers, and ease the strain it can cause."

The study population aims to be representative of the American public. So, if the rates hold true at a national level, more than 3.1 million more American seniors had in-home help in 2012 than did in 1998.

Differences emerge

Over the study period, people with educations beyond high school and above-average net worth saw greater increases in paid caregiving compared with people with less education and less wealth. This suggests growing socioeconomic disparities in receipt of paid caregiving by disabled seniors.

This may also suggest a trend toward aging in place even among those who might be more likely to afford a nursing home.

Even so, about two-thirds of men and 45 percent of women had no caregiving help at all. That's despite the fact that they all had at least some trouble handling routine daily tasks like preparing meals, getting dressed, going to the bathroom or managing their medications.

As might be expected, spouses and adult children were the most common caregivers, and the percentage of seniors reporting that they got help from these sources rose. So did the percentage who said they received help from other family members.

The largest rise was in paid caregiving, while the percentage who received help from friends stayed flat. Paid caregiving can include help that's paid for out of a person's savings, or in some cases with Medicaid and Medicare funds for those who qualify.

Next steps and policy implications

Ankuda and senior author Deborah A. Levine, M.D., M.P.H., an assistant professor of internal medicine, are working on other research about caregiver strain.

The demands of caregiving for a disabled spouse or elder may lead to burnout, and in the case of younger caregivers, create missed professional and educational opportunities that could affect their futures.

"Caregivers are critical to maintaining the health and well-being of disabled older adults yet are largely unrecognized in our care systems," says Levine. "Although caregiving can have benefits, it can also have serious risks for the caregiver including depression and worse health. So supporting caregivers is critical to maintain their health and well-being as well."

Some states have begun providing payment to family members who care for disabled people at home, mainly through Medicaid. Other policies regarding guaranteed paid leave from work, and charity programs in the community and through houses of worship, can also assist.

The sizable population of disabled seniors who got no in-home help could also represent another opportunity, they say. It is possible that getting more disabled seniors connected with care could benefit them and reduce healthcare costs from emergency room visits and nursing home care.

Some of these individuals may just need caregiving for a short while -- while recovering from surgery, for instance. Others may need longer-term care to help them stay safely in their homes. Those who are too well-off to qualify for Medicaid, but have no family caregivers available, nor enough money to pay for help, might be especially important to focus on.

"A growing body of research on caregivers really emphasizes that the experience of caregiving is a common experience, especially for middle-aged and older women," says Ankuda. "Caregivers are clearly not unique in their situations, but are often isolated because we don't recognize them as a formal part of the medical system. They're an unseen, unpaid workforce that could be supported better."
-end-
Ankuda is a member of the Department of Family Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program at the U-M Medical School. Levine is a member of the Departments of Internal Medicine and Neurology at the U-M Medical School, the Veterans Affairs Center for Clinical Management Research at the VA Ann Arbor Healthcare System, and the U-M Institute for Healthcare Policy and Innovation.

Ankuda was supported by her Robert Wood Johnson Foundation fellowship and Levine was supported by grant AG040278 from the National Institute of Aging. The Health and Retirement Study is funded by the National Institute on Aging (AG009740), and performed at the Institute for Social Research, University of Michigan. This study also used the RAND Health and Retirement Study Data file, developed at RAND with funding from the National Institute on Aging and the Social Security Administration.

Reference:JAMA, doi:10.1001/jama.2016.6824, http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.6824

University of Michigan Health System

Related Aging Articles:

The first roadmap for ovarian aging
Infertility likely stems from age-related decline of the ovaries, but the molecular mechanisms that lead to this decline have been unclear.
Researchers discover new cause of cell aging
New research from the USC Viterbi School of Engineering could be key to our understanding of how the aging process works.
Deep Aging Clocks: The emergence of AI-based biomarkers of aging and longevity
The advent of deep biomarkers of aging, longevity and mortality presents a range of non-obvious applications.
Intelligence can link to health and aging
For over 100 years, scientists have sought to understand what links a person's general intelligence, health and aging.
Putting the brakes on aging
Salk Institute researchers have developed a new gene therapy to help decelerate the aging process.
New insights into the aging brain
A group of scientists at the Gladstone Institutes investigated why the choroid plexus contains so much more klotho than other brain regions.
We all want 'healthy aging,' but what is it, really? New report looks for answers
Led by Paul Mulhausen, MD, MHS, FACP, AGSF, colleagues from the American Geriatrics Society (AGS) set looking critically at what 'healthy aging' really means.
New insight into aging
Researchers at the Montreal Neurological Institute and Hospital (The Neuro) of McGill University examined the effects of aging on neuroplasticity in the primary auditory cortex, the part of the brain that processes auditory information.
Aging may be as old as life itself
Aging has had a bad rap since it has long been considered a consequence of biology's concentrated effort on enhancing survival through reproductivity.
A new link between cancer and aging
Human lung cancer cells resist dying by controlling parts of the aging process, according to findings published online May 10th in the Journal of Biological Chemistry.
More Aging News and Aging Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.