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.