Federal Minimum Wage Expansion and Home Care Utilization and Costs for Older Adults

抽象的。超过70%的65岁或65岁以上的老年人需要照顾者的帮助， 在美国有超过600万老年人患有阿尔茨海默氏症 疾病和阿尔茨海默病相关痴呆（AD/ADRD），需要比 他们的对手没有AD/ADRD。随着美国人口老龄化，越来越多的人寻求在他们的年龄 家庭，而不是移动到机构护理设施，如疗养院，有大量的需要， 家庭保健和支持服务。因此，家居照顾工作者提供的家居照顾服务 在美国的医疗体系中扮演着越来越重要的角色。事实上，家庭护理工作已经成为 全国发展最快的职业之一《联邦公平劳动标准法》（1938年） 将家庭护理人员排除在联邦最低工资和加班保护之外， “陪伴豁免”，这有助于家庭护理的具有挑战性的劳动力市场条件 这可能会对劳动者产生不利影响，进而对需要高质量家庭护理服务的老年人产生负面影响。 2013年，劳工部缩小了“陪伴豁免”范围，并颁布了《家庭护理法》， 规则”（HCR），允许某些类型的家庭护理服务受到联邦最低工资的保护， 加班规则新的HCR于2015年1月生效。这种新的HCR影响状态不同， 在最低工资豁免、费率和加班费方面， 我们在这项研究中探索的一个自然实验，提供了第一个关于 新的HCR关于老年人对家庭（和其他形式）护理的利用和支出。我们将使用 差异中的差异和事件研究方法沿着大型的、具有全国代表性的数据集， 在这项准实验研究中，我们追求以下两个相互关联的目标：目标1：我们将测试新的 使用自我报告的个人水平测量，HCR改变了老年人对家庭护理服务的利用率 健康与退休研究（HRS）数据的利用率以及 由医疗保险和医疗补助服务中心开发的地理变异公共使用文件。目的 #2：我们将使用相同的两项测试新的HCR如何改变老年人在家庭护理方面的支出 目标1A的数据集。我们将探讨新的HCR对老年人利用 以及家庭护理沿着支出，包括使用HRS数据的AD/ADRD状态。这 这项研究直接服务于NIH PAS-19-391的总体目的，即“......提供所需的科学见解， 改善对阿尔茨海默病患者的预防、诊断、治疗和/或护理，以及 阿尔茨海默病相关痴呆症（AD/ADRD）”通过“利用现有数据”。这项研究的结果将 具有重大的政策影响，因为老年人口的规模和预期寿命，特别是 AD/ADRD患者人数增加，医疗保健费用持续上升。 1

Abstract. Over 70 percent of older adults aged 65 or older require assistance from caregivers with basic functions at some point in their lifetime, and more than six million older adults in the US have Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) and require more extensive assistance than their counterparts without AD/ADRD. As the US population is aging and more people seek to age in their homes instead of moving to institutional care facilities such as nursing homes, there is a substantial need for in-home healthcare and supportive services. Home care services provided by home care workers therefore play an increasingly crucial role in the US health care system. Indeed, the home care workforce has become one of the fastest growing occupations in the nation. However, the Federal Fair Labor Standard Act (1938) excluded home care workers from the federal minimum wage and overtime protection under the “companionship exemption”, which contributed to the challenging labor market conditions for home care workers and could in turn have a negative impact on older adults who needed high-quality home care services. In 2013, the Department of Labor narrowed the “companionship exemption” and promulgated the “Home Care Rule” (HCR) by allowing certain types of home care services to be protected by federal minimum wage and overtime rules. The new HCR came into effect in January 2015. This new HCR affected states differently due to variations in pre-existing state regulations on minimum wage exemptions, rates and overtime pay, providing a natural experiment that we explore in this study to provide the first empirical evidence on the effects of the new HCR on older adults’ utilization of and spending on home (and other forms of) care. We will use difference-in-differences and event-study approaches along with large, nationally representative datasets to pursue the following two interrelated aims in this quasi-experimental study: Aim #1: We will test how the new HCR has changed older adults’ utilization of home care services, using self-reported individual-level measures of utilization from the Health and Retirement Study (HRS) data and county-level measures of utilization from the Geographic Variation Public Use File developed by the Center for Medicare and Medicaid Services. Aim #2: We will test how the new HCR has changed older adults’ spending on home care, using the same two datasets for Aim 1A. We will explore the heterogeneous effects of the new HCR on older adults’ utilization of and spending on home care along key dimensions including their AD/ADRD status using the HRS data. This study directly serves the overall purpose of NIH PAS-19-391, namely, “…to provide needed scientific insight to improve the prevention, diagnosis, treatment, and/or care for individuals with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD)” by “leveraging existing data”. Findings from this study will have significant policy implications, as the size and the life expectancy of the older adult population, especially the population with AD/ADRD, and the costs of health care continue to rise. 1