Millions of Americans living in the community have moderate to severe limitation in performing basic daily activities. Families provide the bulk of care for these individuals but also may need assistance from home health care professionals. Use of home care services is strongly and positively related to functional impairment, or the inability to care for oneself. Need becomes intensified for those with self-care limitations in the time prior to death. Current public policy provides minimally for home care reimbursement for long-term home care. The purpose of this study is to examine a sample-of noninstitutionalized, functionally-impaired adults in the last year of life to determine if they needed and received assistance at home and to identify variables related to type of assistance received. The 1986 National Mortality Followback Survey (NMFS), a sample of over 18,000 individuals who died in 1985 and 1986, will be the data source. The NMFS affords an opportunity to examine a sample of functionally dependent persons during the last year of life, when they may have been in their' most dependent state and therefore at greatest risk for a high intensity of health service consumption, including home care service. It is critical to gain an understanding of the needs of the functionally impaired in the last year of life and learn more about their patterns of use of health care services. Multivariate regression analysis techniques will be used to analyze the data. Logistic stepwise regression with block inclusion of variables will allow for a dichotomous dependent variable (use or nonuse of service). Groups of variables classed as precondition, risk, family, community, and policy/economic variables will be entered in blocks. Three regression models and two hypotheses will be tested. The findings will contribute to knowledge about the functionally impaired, their needs, and use of home care in the last year of life. The results will assist policy-makers in their on-going efforts to understand and address the overall long-term care needs of the U.S. population.
