Theses Doctoral

Home health care for persons with cognitive impairment

Kaplan, Daniel Barnett

The elderly population is rapidly growing in all nations. With advanced age comes the risk for age-associated illnesses, such as disorders of dementia. People with neurocognitive disorders of dementia experience impaired cognition and require increasing support and care. They also experience numerous behavioral and psychiatric syndromes as these disorders progress. Their care needs are complex and multidimensional, causing great difficulty and high rates of burnout among informal and formal caregivers and subsequent premature institutionalization. Yet research aiming to discover methods for delaying costly institutional care of people with neurocognitive disorders has focused primarily on bolstering family caregiver capacities. Knowledge gaps pertaining to the use of formal services raise serious concerns. The capacity of the home health care service industry to adequately meet the needs of people living with cognitive impairment is highly questionable. This study adapts the Anderson-Newman Health Services Utilization Model and uses newly available health services survey data to make novel comparisons of service use and cost between consumers with moderate-to-severe cognitive impairment and those with little-to-no cognitive impairment. Previously unstudied agency characteristics are also examined in relation to service utilization, and multilevel analyses examine agency characteristics that influence the relationship between consumer cognitive impairment and service use. The findings of this study demonstrate that home health care consumers with moderate-to-severe cognitive impairment, as compared to consumers with little-to-no cognitive impairment, are less likely to have a spouse, their informal caregivers are more likely to be other family members, and they are more likely to be enrolled in health insurance programs for people living in poverty. They typically have more needs for care, more co-occurring illnesses, greater medical needs, and disabilities that are more severe and long-lasting. Home health care consumers with moderate-to-severe cognitive impairment receive services for many more days, including more medical and non-medical service visits, and are more likely to be readmitted to home health care as compared to their less impaired peers. Excess costs of service associated with significantly higher durations and intensities of service are more likely to be expended on multiple occasions because of readmission. This study also identifies compelling factors that significantly influence the relationship between cognitive impairment and service volume and cost. The most influential factor in determining service costs is the insurance program used to pay for services. Several other characteristics of provider agencies found to significantly influence the relationship between consumer cognitive status and service volume include the number of annual admissions, the size of the array of referral sources, the number of years in business, the provision of care, counseling, health, and social services, the number of full-time employees providing care services and health services, entry-level wages for home health aides, instrumental incentives offered to direct care workers, and retention rates for home health aides and personal care aides. These findings are used to inform recommendations for future research and policy efforts.



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More About This Work

Academic Units
Social Work
Thesis Advisors
Burnette, Denise
Ph.D., Columbia University
Published Here
May 30, 2013