The broad objective of this research is to contribute to the understanding of the complex dynamics of? population aging and long-term care. This dissertation research will consist of three distinct but? complementary studies that will evaluate different dimensions of these dynamics, with a focus on? informal (or unpaid) care, the most common form of long-term care in the U.S. The first proposed? study will assess whether, and to what extent, informal care substitutes for paid home care. This? study will use a natural experiment that emerged out of the implementation of an Interim Payment? System that established payment caps for Medicare home health services in 1997. The main goal of? this study is to test whether older adults with functional limitations who lived in states with more? restrictive Medicare payment caps compensated for reductions in paid home care with increased? informal care. The secondary goal of this first study is to test whether this effect varied by level of? income. The second proposed study focuses on the supply of informal care. This study will? investigate the effects of women?s labor force participation on the amount of informal care that they? deliver and on women?s co-residence with an older parent with functional limitations. To assess the? effect of women?s employment on these two outcomes, the research design relies upon natural? experiments that arose out of changes in social policies such as the Earned Income Tax Credit and? welfare reforms. The third proposed study will extend this analysis to focus on other long-term care? outcomes. Because informal care can substitute for other forms of long-term care, I will use a similar? methodology to assess whether social policies that affected women?s employment also affected paid? home care or nursing home use. This research will illustrate how social policies that do not directly? address long-term care or aging may nevertheless have an important impact on health care for older? adults.
| Golberstein, Ezra; Grabowski, David C; Langa, Kenneth M et al. (2009) Effect of Medicare home health care payment on informal care. Inquiry 46:58-71 |
