Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences
(2004). Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences. Journal of Gerontology: Social Sciences, 59(2), pp.S98-S108. doi: 10.1093/geronb/59.2.S98
Using data from the 1994-97 National Health Interview Survey on Disability (NHIS-D), this paper examines the association between the perceived unmet need for personal assistance services (PAS) in activities of daily living (ADLs) for non-elderly adults and the reduced hours of help received, as well as the adverse consequences that arise from this lack of help.
In order to determine the shortfall in hours associated with unmet need, a two-part multivariate regression model of the probability of PAS use and hours of help used, was developed, controlling for need level, living arrangements, and other characteristics that may differ between persons with met and unmet needs.
Individuals with unmet need for personal assistance with 2 or more of the 5 basic ADLs had a shortfall of 16.6 hours of help per week compared to those whose needs are met. Those with unmet need are more likely than those without unmet need to be nonwhite, to be female, and to live alone, as well as to have a greater numbers of ADLs and IADLs for which they need help and higher rates of adverse consequences in 48 of 53 measures. The shortfall in hours as a percent of needed hours is twice as great for persons who live alone as for those who live with others (43.7% v. 19.5%, representing an additional 16.0 hours for those who live with others and receive 66.1 hours of help versus an additional 18.7 hours for those who live alone and receive only 24 hours of help). Both groups are more likely than those whose needs are met to experience adverse consequences in 29 out of 34 measures tested, including discomfort, weight loss, dehydration, falls, burns, and dissatisfaction with the help received. However, people who live alone and have unmet need are 10 times as likely to go hungry (24.5 % v. 2.1 %), 20 times more likely to miss a meal (15.3% v. 0.7%) and 5 times as likely to lose weight (52.2% v. 10.0%).
Overall, just 6.6 percent of needed hours are unmet among the 3.3 million people needing help in 2 or more ADLs. From this data, it can be estimated that the annual cost of eliminating unmet need among persons with incomes under 300% of the SSI level is between $1.2 and $2.7 billion for those living alone, and from $2.2 to $7.1 billion for those living with others.
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