Home-Based Care Increases 20%, But Many Still Left Out

There has been a sharp spike in the number of seniors receiving in-home help, with the greatest increase among those paying for the services.

Half of disabled seniors had some form of in-home help in 2012, which is up nearly 20% since 1998, according to a recent study published in the latest issue of JAMA by a team at the University of Michigan Medical School.

The largest increase for in-home caregivers was seen among those who had milder disabilities, which may be due to these seniors hoping to age in place, the study suggests. If the rate of increase found in the study were applied to the American public, as a whole, there were 3.1 million more seniors in the U.S. who had in-home help in 2012 than there were in 1998.

“Caregiving is essential for keeping people at home and out of nursing homes. But we were surprised by the size of the increase from 1998 to 2012,” Claire Ankuda, M.D., the study’s lead author and a Robert Wood Johnson Clinical Scholar at U-M’s Institute for Healthcare Policy and Innovation, said in a prepared statement.

There was also a large disparity between older disabled adults who were less educated and had less wealth and older disabled adults who were educated and had wealth, the study found.

The numbers for in-home caregivers were higher for those seniors who had more wealth than those with less wealth.

“We need to make sure all older adults are receiving the informal and formal caregiving that they need, not just those who have more wealth,” Deborah A. Levine, M.D., senior author of the study, told Home Health Care News.

When comparing informal in-home caregiving and formal in-home caregiving, spouses and adult children were found to be the most common informal in-home caregivers and also saw an increase from 1998 to 2012. The largest rise was in formal, paid in-home caregiving, and the number of seniors who received in-home help from friends stayed flat.

Given the sharp increase of in-home caregiving in the last decade or so, there will be a greater need for in-home caregivers in the future as the Baby Boomers age, explains Levine.

“We suggest that there will be an increased demand for in-home care, both formal and informal, as a greater number of older adults age in place at home,” she says.

The rise in in-home caregiving in the future also means that ways to help caregivers need to be recognized. There are benefits to caregiving and some states have started providing payment to family members who care for disabled people at home. But there are also risks including caregiver strain, increase risk of depression and other health problems, and opportunity costs like giving up their jobs and other activities in their own lives, Levine points out.

“As we see more of an emphasis by seniors on staying in their homes, and valuing their independence, and as the size of the senior population grows, we need to be thinking as a society about the potential ways to help caregivers, and ease the strain it can cause,” Ankuda said.

Written by Alana Stramowski