Nearly 18 million older adults, or nearly half of everyone 65 and older, report that they need some assistance with routine daily activities. That’s significantly more than generally believed and suggests that the burden on families and the overall care system may be much greater than previously thought.
According to a new study by Vicki Freedman of the University of Michigan and my Urban Institute colleague Brenda Spillman, about 11 million of those 18 million seniors were getting help in some form—usually from a family member or friend and less frequently from a paid aide. Their study was published in the September, 2014 issue of the Milbank Quarterly (behind a pay wall).
The research was based on a new national survey called the National Health and Aging Trends Study (NHATS), which did in-depth, in-person interviews with more than 8,000 older adults beginning in 2011.
Previous research found that about 7 million people 65 and older (and about 12 million of any age) rely on support from others to help with their care needs.
Why did Spillman and Freedman find a higher level of need than early studies? To start, they were working from a different, more current survey. The NHATS also asked people if they received care at any time during the month prior to the survey, while other studies looked at shorter periods of time. And they included a broader definition of mobility limitations than earlier studies.
They report that of the roughly 11 million older adults who receive help, the vast majority—8.2 million—live in community settings. About 1 million live in nursing homes and about 1.6 million in various other forms of supportive care (which might include assisted living, continuing care communities, small board-and-care homes, and the like).
The study also provided important new information about caregivers. Not surprisingly, nearly all those needing assistance receive help from family members or friends. On average, seniors have an informal network of 2 or 3 people but more than one-third have only one. Less than 3 percent have no-one. Spillman and Freeman estimate that more than 20 million people are providing unpaid assistance to older adults with care needs (excluding those living in nursing homes).
Among those living in places other than nursing homes, about one-third receive paid assistance (including help from staff) and about one-third get assistance from both paid staff and family and friends. About 15 percent of those living in supportive care settings hire private duty aides to provide additional assistance.
Nearly all seniors living in the community who need assistance get some help from family members or friends. About 60 percent of those caregivers are spouses, partners, or children.
Not surprisingly, the amount of help people receive varies greatly by level of need. But it was eye-opening across- the-board. Those getting help with household activities such as cooking and cleaning say family and friends provide an average of about 85 hours- a-month of assistance (about 21 hours-a-week). But those getting help with 3 or more personal care or mobility needs such as bathing or walking say family and friends give more than 250 hours of assistance. That’s more than 60 hours per week.
Freedman and Spillman also reported important information about the consequences of inadequate care. Nearly one in six of all older adults reported at least one “adverse consequence” when a care need was not met. And among those who said they needed assistance, it was nearly one-third. The most common effects: Wet or soiled clothes, being unable to go places, or making mistakes taking medications.
This important study will surely set off a strong debate about how many older adults do need care and how much assistance they require. But NHATS is an important new resource. And Spillman and Freedman have mined some choice nuggets that give us an even greater sense of urgency as we think about care needs for older Americans and the lives of their family members.
I’m Occuparional Therapy in Gerontology. In my experience when I visit elders in his home I found inaccesibility or un safety homes. The lack of assistive divices like shower chair, grab bars, commodes, reacher, long handled spnge…. Limite elders to integrates in ADL’s.
I have recently opened my own business here in the State of Maryland and we focus on serving our seniors in three counties. I am always looking to find inforamtion and continue to learn and hopefully one day be an expert or close to it in this field or at worst be a fantastic resource to my community. I read your article dated October 8, 2014, very good article. I would like to perhaps use it or possibly put out on my web-site. Im looking to create a “Resource Tool Box for Seniors” where they can find good reading material or their siblings can gather current material to help them make great decisons for their loved ones.
Thanks for your time and consideration,
Howard, This is a surprising–rather alarming–finding.
I’d be very interested to know what health conditions or combinations of conditions cause people 65 and older to need some assistance with routine daily activities.
My husband and I are both well over 65 but don’t yet require help with routine daily activities. We divide those according to talent and experience. For example, I do nearly all the cooking and food shopping, and he does all the planning and most of the driving on longish trips. But then I did most of the shopping for food and cooking for decades before I met my husband.
Recently, we’ve discussed having a cleaning company come in every week or two–because we both have other work to do.
This article was recently shared by a case manager in my network. I provide in-home senior care to provide support for both seniors and family caregivers who need regular help to live at home and maintain health and safety. Common changes (and their effects) include deteriorating vision (driving errors, accidents, getting lost), falls (loss of balance, tripping), loneliness after loss of a spouse, isolation due to illness, or lessening ability to participate in activities. Waiting on help does not save money! As an experienced RN, I am distressed that many seniors and family caregivers delay way too long before getting help,until a crisis happens – a fall, injury, or depression – before seeking advice or even minimal assistance. It is worth getting help when life gets a little harder!
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