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A Profile of Frail Older Americans and Their Caregivers

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Document date: March 01, 2006
Released online: March 01, 2006

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

Note: This report is available in its entirety in the Portable Document Format (PDF).

The text below is a portion of the complete document.


Executive Summary

Frail older adults are one of the most vulnerable groups in the nation. Disproportionately female, widowed, and in their 80s and 90s, most older people with disabilities living outside of nursing homes have little education and limited financial resources. Given the scarcity of public financing for home-based care, about three-quarters of frail older people receiving assistance rely exclusively on unpaid caregivers. Yet providing help to these older Americans can be a substantial burden on spouses, children, and friends. As a result, some frail older adults do not receive the help they need. As the population ages, the demands on government and families will only intensify and put more older people at risk.

This report uses data from the 2002 Health and Retirement Study (HRS) to profile older Americans and their caregivers. Focusing on people age 65 and older who are not in nursing homes, the study examines frail older adults and the subgroup with severe disabilities. Those defined as frail have difficulty with at least one personal care activity or other activity related to independent living; the severely disabled are unable to complete three or more personal care activities. Personal care activities include bathing, dressing, and getting in and out of bed. Other activities related to independent living include shopping for groceries and taking medications.

The community-based disabled population is sizeable. In 2002, about 8.7 million people age 65 and older living at home, or 26.5 percent of the population, reported some type of disability that limited their ability to perform basic personal activities or live independently. About 6.1 percent, or 2.0 million people, were severely disabled. By comparison, about 1.4 million older people lived in nursing homes in 2002.

Mental health problems are widespread within the frail older population. About 31 percent of frail older adults and 45 percent of those with severe disabilities suffer from depression. Mental health services for older people with disabilities are scarce.

Many frail older people live alone. In 2002, 35.0 percent of older adults with severe disabilities and 57.2 percent of unmarried older adults with severe disabilities lived alone. They face special challenges in the receipt of long-term care because caregivers are often not immediately available when emergencies arise.

Most frail older people who do not live in nursing homes have children nearby who could provide assistance. About 9 in 10 older adults with disabilities have surviving adult children. Despite concern about the dispersion of the American family, 62.5 percent of frail older adults have at least one child living within 10 miles.

Most frail older people have only modest financial resources. In 2001, the median income for older people with severe disabilities living at home was only $14,160. Nearly one-quarter had incomes below the federal poverty level. Median household wealth among those with severe disabilities totaled $47,913, nearly three-fourths of which was tied up in their homes. Median financial assets amounted to only $7,908, leaving many severely disabled older people with little liquid wealth for meeting long-term care and other needs.

Few qualify for public benefits or purchase private long-term care insurance. Medicare does not cover most long-term care services. Medicaid provides many long-term care services to beneficiaries, but only people with little income and virtually no assets qualify. In 2002, only 15.5 percent of frail older adults and 27.3 percent of those with severe disabilities had Medicaid coverage. Private insurance coverage is expensive and beyond the reach of most older people. Only 10.2 percent of Americans age 65 and older had long-term care insurance coverage in 2002, including only 6.8 percent of frail older adults.

Many, but not all, frail older people living at home receive assistance from family and friends. In 2002, 61.3 percent of frail older adults who did not live in nursing homes received help with basic personal activities or with household chores from paid and unpaid caregivers. Those receiving care obtained 177 hours of help per month, on average. Among older adults with severe disabilities living at home, nearly 9 in 10 received help, and care recipients averaged 289 hours of help per month.

Paid help is rare. Only 14.3 percent of frail older adults and 36.6 percent of older adults with severe disabilities received paid home care services in 2002. Paid help accounted for 18 percent of the assistance frail older adults living at home received and 22 percent of the assistance those with severe disabilities received.

Providing help can overwhelm caregivers. Most older people receiving help obtain assistance from only one unpaid caregiver, generally a spouse or daughter. Caregiving responsibilities often create substantial burdens for family helpers, many of whom work outside the home or struggle with their own health problems.

  • About two-thirds of older care recipients obtain help from only one unpaid caregiver.
  • Unpaid caregivers who assume primary responsibility for the personal care of frail older adults average 201 hours of help per month, more than the typical full-time job.
  • More than 9 out of 10 frail older care recipients who are married obtain help from their spouses.
  • More than half of frail older care recipients who are unmarried obtain help from their daughters, including nearly two-thirds of those receiving help with basic personal care.
  • More than half of adult children helping their frail older parents are employed.
  • About one in three spouses caring for frail older adults describe their own health as only fair or poor, and more than one in five have disabilities of their own.

Some frail older adults lack the help they need. Only 53.1 percent of frail older people living alone received regular care in 2002. On average, older women with serious disabilities received 63 hours less care per month than their male counterparts, a shortfall of about 23 percent.

Policy Implications

The study findings highlight several policy issues, including the limited government support for long-term care services to older Americans living at home. Six times as many older people with disabilities live at home as in nursing homes, yet two-thirds of long-term care expenditures for older people go to institutional care.

Long-term care is a women's issue. Women account for most of the older people who receive care and most of their caregivers.

  • Nearly two-thirds of older people with severe disabilities are female.
  • Women account for about two-thirds of all unpaid caregivers.
  • Daughters account for about 7 of every 10 adult children who help their frail parents and about five of every six who assume primary responsibility for their personal care.

The aging of the baby boomers will likely intensify long-term care demands on government and families. Between 2000 and 2050, the size of the population age 85 and older will soar from 4.3 million to 20.9 million, increasing the number of people in need of care. The availability of family caregivers may also decline over time because of rising divorce rates, increasing childlessness, declining family sizes, and rising employment rates of married women. Additional support for home- and community-based care is likely to be necessary to keep many frail older Americans out of nursing homes.

Note: This report is available in its entirety in the Portable Document Format (PDF).



Topics/Tags: | Health/Healthcare | Retirement and Older Americans


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