Abstract Risk factors associated with the incidence of recipient injuries, bedsores and contractures, and health care use (i.e., emergency department and hospital use) among aged and non-aged adult personal care recipients are investigated. Data are from a statewide survey of aged and non-aged adult personal assistance service (PAS) recipients (n = 913) in California's In-Home Supportive Services (IHSS) program. This is a consumer-directed PAS program. Outcomes among recipients using relatives (other than spouses or parents) as paid providers are compared with those of recipients having non-relatives as providers. No differences were found by provider-recipient relationships. Non-aged recipients, those in poorer health, those with more than three activities of daily living (ADL) limitations, and those changing providers during the year were all at greater risk for adverse health outcomes. African American, Hispanic, and Asian recipients were at lower risk for injuries and hospital stays than were White recipients. Keywords: consumer-directedhome and community-based servicespersonal care Acknowledgments The research reported was performed with the permission of the California Department of Social Services (CDSS) under funding from the National Institute for Occupational Safety and Health (NIOSH; R01 OH008759-01A1) and the National Institute for Disability and Rehabilitation Research (NIDRR; #H133B031102). The authors acknowledge CDSS as the source of the Case Management, Information and Payrolling System (CMIPS) data used in these analyses. The opinions and conclusions expressed herein are solely those of the authors and should not be considered as representing the policy of any agency of the California State Government, the National Institute for Occupational Safety and Health, or the National Institute for Disability and Rehabilitation Research. Notes 1. The research protocol was approved by the state Committee for the Protection of Human Subjects (#06-02-03), University of California–San Francisco Committee for Human Research (#H945-28245), and San Francisco State University's Committee for the Protection of Human Subjects (H8-012R1). 2. CMIPS has three cognitive limitations questions. These, respectively, evaluate memory, orientation, and judgment; each scored to indicate whether human assistance is required relative to these functions. A report released by the Office of the Assistant Secretary for Planning and Evaluation (CitationNewcomer & Kang, 2008) showed that 2.9% of the aged IHSS recipients had one or more cognitive functions needing at least human assistance. This prevalence estimate appears to undercount the prevalence of cognitive limitations in the IHSS population, as it is substantially below prevalence estimates for dementia in the aged population more generally. Alzheimer's disease and related dementia (ADRD) affect 3–11% of the elderly with prevalence increasing dramatically with age such that more than 47% of persons 85 or more are estimated to have ADRD (CitationU.S. General Accounting Office, 1998).
Objectives. Perceived unmet need for personal assistance services (PAS) in activities of daily living (ADLs) and instrumental ADLs and its association with reduced hours of help received and with adverse consequences due to lack of help are examined for adults aged 18 and older using data from the 1994–1997 National Health Interview Survey on Disability.
Abstract This study examined service use and expenditures for people with intellectual and developmental disabilities (IDD) living at home and in the community in California in 2005 and 2013. The number of people assessed for IDD services increased, along with the percentage of individuals who did not receive any services between 2005 and 2013. Controlling for client needs, children age 3–21 were less likely than other age groups to receive any services using logistic regressions. All racial and ethnic minority groups were less likely to receive any services than were white populations. Females, younger people, and all racial and ethnic minority groups who received services had significantly lower expenditures, with wide geographic variations. The disparities by age, gender, race/ethnicity, and geography have persisted over time in California.
This study examined factors associated with the use of personal care services (PCS) and the amount of authorized hours in California in 2004–2005. Of those Medicaid‐eligible individuals with developmental disabilities living at home, 31% received PCS. When we controlled for client need, gender, and age, individuals who were Asian/Pacific Islanders, African Americans, Hispanics, and other races had higher odds of receiving PCS than Whites but were authorized between 16 and 39 hours fewer than Whites.
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