The Patient Protection and Affordable Care Act—health care reform—fundamentally changed health insurance and access to health care. Our researchers are unpacking the landmark law, studying the challenges of implementation, and using our Health Insurance Policy Simulation Model to estimate how its proposals will affect children, seniors, and families, as well as doctors, small businesses, and the national debt.
The Urban Institute also studies cost, coverage, and reform options for Medicare and Medicaid and analyzes trends and underlying causes of changes in health insurance coverage, access to care, and Americans’ use of health care services. Read more.
This study profiles older adults receiving assistance with physician visits and prescribed medications and the time demands associated with their care, using nationally representative data on Americans age 65 or older from the 2011 National Health and Trends Study. More than one in three older adults receives assistance with either physician visits or prescribed medications or both. Those receiving assistance with both physician visits and medications are a high-need subgroup: 60% have possible or probable dementia and 75% receive help with mobility, self-care, or household activities. They receive more than twice as many weekly hours of help with all activities as those receiving help with either physician visits or prescribed medications, and three times as many hours as those receiving neither type of assistance. Older adults receiving help with both physician visits and prescribed medications are assisted by 7.2 million helpers, most often adult children or spouses. The 3.1 million helpers who assist with both physician visits and prescribed medications provide an average of 45.4 hours of help per week; nearly two thirds also assist with mobility or self-care.
Older adults with physical or cognitive limitations live in a variety of settings from traditional community housing to nursing homes. This analysis of data from the 2011 National Health and Aging Trends Study provides new estimates of the older population across settings and examines unmet needs for assistance. Of 38.1 million Medicare beneficiaries ages 65 or older, 2.5 million live in retirement/senior housing communities, nearly 1 million in independent- and 1 million in assisted-living settings, and 1.1 million in nursing homes. The prevalence of assistance is higher and physical and cognitive capacity lower in each successive setting. Unmet needs are common in traditional housing (31%), but most prevalent in retirement/senior housing (37%) and assisted living settings (42%). Different resident characteristics account for some of the differences across settings, but after controls for individual characteristics, those in retirement/senior housing still have a higher likelihood of unmet needs than those in traditional community. Prevalent unmet needs older adults with limitations across all settings and warrant further investigation and monitoring.
Nearly half of U.S. adults over age 65 (18 million) have difficulty or receive help with daily activities, according to data from the National Health and Aging Trends Study. Nearly all who receive help in settings other than nursing homes—including assisted living and other supportive care settings—receive informal care, and about 30% receive some paid care. Those receiving assistance from paid, non-staff caregivers have especially high rate of adverse consequences related to unmet needs (nearly 60%). Nearly 3 million older adults live in settings other than nursing homes and receive help with three or more self-care or mobility activities, exceeding the level of need typically associated with eligibility for benefits under private insurance or public programs. A disproportionate share of this group is in the lowest income quartile. Although publicly and privately paid care continues to be an important source of assistance to older adults with extensive needs, the higher level of adverse consequences linked to unmet need among those receiving paid care warrants further investigation, particularly because of continuing shifts of long-term care from nursing homes to other settings.
Results in this study underscore the substantial role of dementia in late-life disability and caregiving to older people. Data are from the 2011 National Health and Aging Trends Study. Among persons not residing in nursing homes, 78% of those with probable dementia received assistance with self-care or mobility activities or household activities for health or functioning reasons, compared with 42% of those with possible dementia and 18% of those with no dementia. Almost half of the 2.7 million older adults receiving help with three or more self-care or mobility activities have probable dementia. Relative to those with no dementia, they are more likely to live in supportive settings and to be low income, non-White, and widowed. One third of informal caregivers are assisting someone with probable dementia and account for 40% of informal care hours. They are three times as likely to report substantial negative impacts of caregiving as those caring for persons with no dementia. They are more likely to use some caregiver support services (respite, training, financial help) and also more likely to be looking for support services.
In 2011, 18 million informal caregivers provided 1.3 billion hours of care monthly to about 9 million older adults receiving informal assistance with daily activities, according to estimates from the new National Survey of Caregiving. Family members continue to be the main source of informal care, and hours of care are concentrated among caregivers for higher need recipients. Informal caregivers provide an average 75 hours per month; hours are significantly more for spouses, other co-resident caregivers, and those assisting high-need recipients. Most caregivers reported substantial positive aspects of caregiving. Those who provide high levels of care, assist recipients with dementia, or have health problems themselves are most likely to report substantial negative aspects of caregiving. Beyond supportive care, most informal caregivers assist with a range of medically-oriented tasks or help recipients navigate the health system, making them an essential part of the workforce for maintaining health and well-being in the older population, as recognized by both the Administration for Community Living (ACL) and the National Plan to Address Alzheimer's Disease.