Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home
(2002). Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home. Health Services Research, 37(2), pp.397-415.
The purpose of this paper was to estimate the total hours of paid and unpaid personal assistance services (PAS) used by U.S. adults (ages 18 and over) living at home according to the number and type of activities of daily living for which they use help.
Data for this paper were taken from the National Health Interview Survey on Disability (NHIS-D), a nationally representative household survey conducted between 1994 and 1997. The sample consisted of 8,471 adults residing in the community who used PAS for up to 5 activities of daily living (ADLs - i.e., bathing, dressing, eating) and 10 instrumental activities of daily living (IADLS - shopping, housework, financial management). For the 22 percent of the sample that was missing data on hours of PAS used, the data were imputed through multiple regression models using demographic, ADL, and IADL variables.
From this data, it was estimated that 13.2 million noninstitutionalized adults receive an average of 31.4 hours of PAS each week. Of these, 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receive an average of 30.7 hour of unpaid help. Persons ages 18-64 used more help than those ages 65 and older (6.9 versus 6.2 million), even though non-elderly adults used fewer hours (27.4 versus 35.9) each week, due in part to less sever levels of disability. In total, noninstitutionalized adults use 21.5 billion hours of PAS each year, with an economic value in 1996 approaching $200 billion. However, paid PAS represents only 16 percent or $32 billion of this. This study, the first to estimate hours of assistance for both working-age and older adults, begins to highlight the division of labor in the provision of PAS documenting that: 1) older persons are more likely to receive paid PAS and 2) working-age people rely to a greater extent on unpaid PAS. These estimates of the hours of paid and unpaid PAS based on ADLs should inform policy concerning eligibility for long term care.
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