Estimating Paid and Unpaid Hours of Personal Assistance Services in Activities of Daily Living Provided to Adults Living at Home

• Published in: Health services research 2002-04, Vol.37 (2), p.397-415
• Main Authors: LaPlante, Mitchell P., Harrington, Charlene, Kang, Taewoon
• Format: Article
• Language: English
• Subjects: Activities of daily living; Activities of Daily Living - classification; Adolescent; Age; Age Factors; Aged; Assistants; Care and treatment; Caregivers; Company financing; Compensation and benefits; Disability; Disabled persons; Disabled Persons - statistics & numerical data; Elder care; elderly; Estimates; Female; Finance; Health Care Surveys; Health Services Research; Home care services; Home care services industry; Home Health Aides - statistics & numerical data; Homemaker Services - economics; Homemaker Services - utilization; hours of help; Households; Humans; imputation; informal help; Linear Models; long term care; Long term health care; Long-Term Care - economics; Long-Term Care - utilization; Male; Middle Aged; Missing data; NHIS-D; Older people; paid help; People with disabilities; Personal assistance services; Polls & surveys; Population; Research Briefs; Statistical analysis; Studies; Time and Motion Studies; United States; working-age
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.029

Objective. To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. Data Sources. The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS‐D) conducted from 1994 to 1997. Data Collection/Extraction Methods. Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household‐resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. Findings. We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18–64 received help than those ages 65 and older (6.9 versus 6.2 million), but working‐age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. Conclusions. Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching 200billion.Only16percentofthistotalispaid,representing32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working‐age and older adults, documents that older persons are more likely to receive paid personal assistance, while working‐age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.