Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home.


OBJECTIVE:To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES:The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conducted from 1994 to 1997. DATA COLLECTION/EXTRACTION METHODS:Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household-resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. FINDINGS:We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18-64 received help than those ages 65 and older (6.9 versus 6.2 million), but working-age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. CONCLUSIONS:Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching $200 billion. Only 16 percent of this total is paid, representing $32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working-age and older adults, documents that older persons are more likely to receive paid personal assistance, while working-age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.


Health Serv Res


Health services research


LaPlante MP,Harrington C,Kang T





Has Abstract


2002-04-01 00:00:00












  • Serious mental illness and nursing home quality of care.

    abstract:OBJECTIVE:To estimate the effect of a nursing home's share of residents with a serious mental illness (SMI) on the quality of care. DATA SOURCES:Secondary nursing home level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims. STUDY DESIGN:We employ an instrumental va...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Rahman M,Grabowski DC,Intrator O,Cai S,Mor V

    更新日期:2013-08-01 00:00:00

  • Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery.

    abstract:OBJECTIVE:To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Schootman M,Lian M,Pruitt SL,Deshpande AD,Hendren S,Mutch M,Jeffe DB,Davidson N

    更新日期:2014-08-01 00:00:00

  • Narrow- and Broad-Spectrum Antibiotic Use among U.S. Children.

    abstract:OBJECTIVES:To provide updated estimates of narrow- and broad-spectrum antibiotic use among U.S. children. DATA SOURCES:Linked nationally representative data from the 2004-2010 Medical Expenditure Panel Survey Household Component and the 2000 Decennial Census. STUDY DESIGN:Relationships between individual-, family-, a...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Sarpong EM,Miller GE

    更新日期:2015-06-01 00:00:00

  • Does community-based health insurance protect household assets? Evidence from rural Africa.

    abstract:OBJECTIVE:To evaluate whether community-based health insurance (CBHI) protects household assets in rural Burkina Faso, Africa. DATA SOURCES:Data were used from a household panel survey that collected primary data from randomly selected households, covering 41 villages and one town, during 2004-2007(n = 890). STUDY DE...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Parmar D,Reinhold S,Souares A,Savadogo G,Sauerborn R

    更新日期:2012-04-01 00:00:00

  • The unintended impact of welfare reform on the medicaid enrollment of eligible immigrants.

    abstract:BACKGROUND:During welfare reform, Congress passed legislation barring legal immigrants who entered the United States after August 1996 from Medicaid for five years after immigration. This legislation intended to bar only new immigrants (post-1996 immigrants) from Medicaid. However it may have also deterred the enrollme...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Kandula NR,Grogan CM,Rathouz PJ,Lauderdale DS

    更新日期:2004-10-01 00:00:00

  • Comparing aggregate estimates of derived thresholds for clinical decisions.

    abstract::Thresholds for medical decision making are the probabilities of disease at which clinicians choose to initiate testing or therapy. A descriptive analysis of clinicians' decision making can derive their test and test-treatment thresholds and has the potential to explain variations in test utilization. A previously desc...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Young MJ,Eisenberg JM,Williams SV,Hershey JC

    更新日期:1986-02-01 00:00:00

  • The Role of Program Directors in Treatment Practices: The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs.

    abstract:OBJECTIVE:To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors' characteristics and low methadone dosage. DATA SOURCE:Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011. STUDY DE...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Frimpong JA,Shiu-Yee K,D'Aunno T

    更新日期:2017-10-01 00:00:00

  • Predictive modeling of housing instability and homelessness in the Veterans Health Administration.

    abstract:OBJECTIVE:To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (VHA). DATA SOURCES/STUDY SETTING:Electronic medical record data from 5.8 million Veterans who responded to the VHA's Hom...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Byrne T,Montgomery AE,Fargo JD

    更新日期:2019-02-01 00:00:00

  • Prescription drug monitoring programs: Assessing the association between "best practices" and opioid use in Medicare.

    abstract:OBJECTIVE:To estimate the impact of implementing prescription drug monitoring program (PDMP) best practices on prescription opioid use. DATA SOURCES:2007-2012 Medicare claims for noncancer pain patients, and PDMP attributes from the Prescription Drug Abuse Policy System. STUDY DESIGN:We derived PDMP composite scores ...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Moyo P,Simoni-Wastila L,Griffin BA,Harrington D,Alexander GC,Palumbo F,Onukwugha E

    更新日期:2019-10-01 00:00:00

  • Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness.

    abstract::Previous research has confirmed that desirable hospital attributes as well as increased distance, or travel time, have an impact on hospital choice. These studies have become increasingly sophisticated in modeling choice. This study adds to the existing literature by estimating the effect of both hospital and individu...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Adams EK,Houchens R,Wright GE,Robbins J

    更新日期:1991-12-01 00:00:00

  • Health-Related Quality of Life among Chronic Opioid Users, Nonchronic Opioid Users, and Nonopioid Users with Chronic Noncancer Pain.

    abstract:OBJECTIVE:Evaluate the association between opioid therapy and health-related quality of life (HRQoL) in participants with chronic, noncancer pain (CNCP). DATA SOURCES:Medical Expenditure Panel Survey Longitudinal, Medical Conditions, and Prescription Files. STUDY DESIGN:Using a retrospective cohort study design, the ...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Hayes CJ,Li X,Li C,Shah A,Kathe N,Bhandari NR,Payakachat N

    更新日期:2018-10-01 00:00:00

  • Comparison of health care utilization: United States versus Canada.

    abstract:OBJECTIVE:To compare health care utilization between Canadian and U.S. residents. DATA SOURCES:Nationally representative 2007 surveys from the Medical Expenditure Panel Survey for the United States and the Canadian Community Health Survey for Canada. STUDY DESIGN:We use descriptive and multivariate methods to examine...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Pylypchuk Y,Sarpong EM

    更新日期:2013-04-01 00:00:00

  • Initial practice locations of international medical graduates.

    abstract:OBJECTIVE:To examine the influence of place of graduate medical education (GME), state licensure requirements, presence of established international medical graduates (IMGs), and ethnic communities on the initial practice location choices of new IMGs. DATA SOURCES:The annual Graduate Medical Education (GME) Survey of ...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Polsky D,Kletke PR,Wozniak GD,Escarce JJ

    更新日期:2002-08-01 00:00:00

  • Do physicians attend to base rates? Prevalence data and statistical discrimination in the diagnosis of coronary heart disease.

    abstract:OBJECTIVE:To examine whether physicians attend to gender prevalence data in diagnostic decision making for coronary heart disease (CHD) and to test the hypothesis that previously reported gender differences in CHD diagnostic certainty are due to discrimination arising from reliance on prevalence data ("statistical disc...

    journal_title:Health services research

    pub_type: 评论,杂志文章


    authors: Maserejian NN,Lutfey KE,McKinlay JB

    更新日期:2009-12-01 00:00:00

  • Modeling the impact of Medicare Advantage payment cuts on ambulatory care sensitive and elective hospitalizations.

    abstract:OBJECTIVE:To assess relationships between changes in Medicare Advantage (MA) payment rates and Medicare beneficiary hospitalizations and to simulate the effects of scheduled payment cuts on ambulatory care sensitive (ACS) and elective hospitalization rates. DATA:State Inpatient Database discharge abstracts from Arizon...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Nicholas LH

    更新日期:2011-10-01 00:00:00

  • Impact of generalist care managers on patients with diabetes.

    abstract:OBJECTIVE:To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes. STUDY SETTING:Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network. STUDY DESIGN:A retrospec...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Dorr DA,Wilcox A,Donnelly SM,Burns L,Clayton PD

    更新日期:2005-10-01 00:00:00

  • Which components of medical homes reduce the time burden on families of children with special health care needs?

    abstract:OBJECTIVES:To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home. DATA SOURCES:2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Miller JE,Nugent CN,Russell LB

    更新日期:2015-04-01 00:00:00

  • Comparing self-reported health status and diagnosis-based risk adjustment to predict 1- and 2 to 5-year mortality.

    abstract:OBJECTIVES:To compare the ability of two diagnosis-based risk adjustment systems and health self-report to predict short- and long-term mortality. DATA SOURCES/STUDY SETTING:Data were obtained from the Department of Veterans Affairs (VA) administrative databases. The study population was 78,164 VA beneficiaries at eig...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Pietz K,Petersen LA

    更新日期:2007-04-01 00:00:00

  • Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care.

    abstract:OBJECTIVE:To examine whether nurse practitioner (NP)-assigned patients exhibited differences in utilization, costs, and clinical outcomes compared to medical doctor (MD)-assigned patients. DATA SOURCES:Veterans Affairs (VA) administrative data capturing characteristics, outcomes, and provider assignments of 806 434 VA...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Liu CF,Hebert PL,Douglas JH,Neely EL,Sulc CA,Reddy A,Sales AE,Wong ES

    更新日期:2020-04-01 00:00:00

  • Tax-Exempt Hospitals' Investments in Community Health and Local Public Health Spending: Patterns and Relationships.

    abstract:OBJECTIVES:To investigate whether tax-exempt hospitals' investments in community health are associated with patterns of governmental public health spending focusing specifically on the relationship between hospitals' community benefit expenditures and the spending patterns of local health departments (LHDs). STUDY DES...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Singh SR,Young GJ

    更新日期:2017-12-01 00:00:00

  • Enhancing the quality of case studies in health services research.

    abstract:OBJECTIVE:To provide guidance on improving the quality of case studies in health services research. DATA SOURCES:Secondary data, drawing from previous case study research. RESEARCH DESIGN:Guidance is provided to two audiences: potential case study investigators (eight items) and reviewers of case study proposals (fou...

    journal_title:Health services research

    pub_type: 杂志文章,评审


    authors: Yin RK

    更新日期:1999-12-01 00:00:00

  • No exit? The effect of health status on dissatisfaction and disenrollment from health plans.

    abstract:OBJECTIVE:To examine the implications of serious and chronic health problems on the willingness of enrollees to switch health plans if they are dissatisfied with their current arrangements. DATA SOURCE:A large (20,283 respondents) survey of employees of three national corporations committed to the model of managed com...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Schlesinger M,Druss B,Thomas T

    更新日期:1999-06-01 00:00:00

  • Specialty and full-service hospitals: a comparative cost analysis.

    abstract:OBJECTIVE:To compare the costs of physician-owned cardiac, orthopedic, and surgical single specialty hospitals with those of full-service hospital competitors. DATA SOURCES:The primary data sources are the Medicare Cost Reports for 1998-2004 and hospital inpatient discharge data for three of the states where single sp...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Carey K,Burgess JF Jr,Young GJ

    更新日期:2008-10-01 00:00:00

  • Advance care planning in nursing homes: pre- and post-Patient Self-Determination Act.

    abstract:OBJECTIVES:(1) To identify resident and organizational factors associated with the use of advance care plans pre- and post-implementation of the Patient Self-Determination Act (PSDA), and (2) to identify changes (pre- and post-implementation of the PSDA) in the relationship between these factors and the use of advance ...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Castle NG,Mor V

    更新日期:1998-04-01 00:00:00

  • Psychometric properties of the patient activation measure among multimorbid older adults.

    abstract:OBJECTIVES:The Patient Activation Measure (PAM) quantifies the extent to which people are informed about and involved in their health care. Objectives were to determine the psychometric properties of PAM among multimorbid older adults and evaluate a theoretical, four-stage model of patient activation. Methods. A cross-...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Skolasky RL,Green AF,Scharfstein D,Boult C,Reider L,Wegener ST

    更新日期:2011-04-01 00:00:00

  • Construct validity comparisons of three methods for measuring patient compliance.

    abstract::A multitrait - multimethod design was employed to assess the construct validity of three commonly used methods for assessing patient compliance: physiological assessments (e.g., blood chemistries), ratings by health professionals, and patient self-reports. Subjects were patients receiving ambulatory hemodialysis treat...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Cummings KM,Kirscht JP,Becker MH,Levin NW

    更新日期:1984-04-01 00:00:00

  • Antitrust enforcement in the healthcare industry: the expanding scope of state activity.

    abstract:OBJECTIVE:To describe the landscape of state antitrust activity and review related research and policy issues. In particular, to examine state laws that attempt to immunize mergers among healthcare providers from state and federal antitrust prosecution and consent decrees issued by state attorneys general permitting he...

    journal_title:Health services research

    pub_type: 杂志文章,评审


    authors: Hellinger FJ

    更新日期:1998-12-01 00:00:00

  • Improving Hospital Reporting of Patient Race and Ethnicity--Approaches to Data Auditing.

    abstract:OBJECTIVE:To investigate new metrics to improve the reporting of patient race and ethnicity (R/E) by hospitals. DATA SOURCES:California Patient Discharge Database (PDD) and birth registry, 2008-2009, Healthcare and Cost Utilization Project's State Inpatient Database, 2008-2011, cancer registry 2000-2008, and 2010 US C...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Zingmond DS,Parikh P,Louie R,Lichtensztajn DY,Ponce N,Hasnain-Wynia R,Gomez SL

    更新日期:2015-08-01 00:00:00

  • Provider networks and health plan premium variation.

    abstract:OBJECTIVE:To examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act's Health Insurance Marketplaces in all 50 states and the DC in 2016. DATA SOURCES:Data on plan premiums and characteristics came from 2016 Robert Wood ...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Polsky D,Wu B

    更新日期:2020-08-13 00:00:00

  • Parental beliefs and children's receipt of preventive care: another piece of the puzzle?

    abstract:OBJECTIVE:To examine whether parental beliefs about routine checkups are associated with children's receipt of timely preventive care. DATA SOURCES:The 2001 United Way Outcomes and Community Impact Program telephone survey of San Diego County, including 918 households with children between 3 and 19 years of age, where...

    journal_title:Health services research

    pub_type: 杂志文章


    authors: Hughes SC,Wingard DL

    更新日期:2008-02-01 00:00:00