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

联邦最低工资扩展以及老年人的家庭护理利用和费用

• 批准号: 10573547
• 负责人: Yang Wang
• 金额: $ 16.16万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10573547
• 关键词: Affect; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Caregivers; Caring; Complex; Cost Analysis; Costs and Benefits; County; Data; Data Set; Diagnosis; Dimensions; Education; Educational Status; Elderly; Ethnic Origin; Event; Exclusion; Family; Friends; Future; Gender; Health; Health Care Costs; Health Insurance; Health Personnel; Health and Retirement Study; Healthcare Systems; Home; Home Care Services; Household; Individual; Institution; Insurance Coverage; Life; Life Expectancy; Literature; Long-Term Care; Low income; Marital Status; Marketing; Measures; Medicaid; Methods; Natural experiment; Nursing Homes; Occupations; Outcome; Patient Self-Report; Persons; Play; Policies; Policy Maker; Population; Positioning Attribute; Prevention; Quasi-experiment; Race; Regulation; Research; Role; Services; System; Testing; Time; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Variant; Wages; aged; care providers; care recipients; cost; design; experience; geographic difference; improved; informal care; innovation; insight; institutional care facility; interest; patient home care; policy implication; pressure; programs

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

抽象的。超过70％的65岁或以上的老年人需要提供基本的护理人员的帮助 在他们一生的某个时刻起作用，在美国有超过600万老年人有阿尔茨海默氏症 疾病和阿尔茨海默氏病与疾病相关的痴呆症（AD/ADRD），需要更多的援助 他们的同行没有广告/adrd。随着美国人口的老龄化，越来越多的人试图在自己的身上衰老 房屋而不是搬到诸如护理家庭之类的机构护理机构，而是非常需要 家庭医疗保健和支持服务。因此，家庭护理人员提供的家庭护理服务 在美国卫生保健系统中起着越来越重要的作用。确实，家庭护理员工已经成为 全国增长最快的职业之一。但是，《联邦公平劳工标准法》（1938年） 在联邦最低工资和加班保护之外，将家庭护理人员排除在外 “陪伴豁免”，促进了劳动力市场的家庭护理条件 工人和可能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”，并颁布了“家庭护理 规则”（HCR）允许某些类型的家庭护理服务受联邦最低工资保护和 加班规则。新的HCR于2015年1月生效。该新的HCR受影响的州应有不同的影响 关于最低工资豁免，税率和加班费的国家规定的差异 我们在这项研究中探索的自然实验，以提供有关效果的第一个经验证据 关于老年人在家庭（和其他形式）护理上使用和支出的新HCR。我们将使用 差异差异和事件研究方法以及大型的全国代表性数据集 在这项准实验研究中追求以下两个相互关联的目标：目标＃1：我们将测试新的 HCR使用自我报告的个人级别措施改变了老年人对家庭护理服务的利用 从健康与退休研究（HRS）数据和县级利用率的利用率 Medicare和Medicaid服务中心开发的地理差异公共用途文件。目的 ＃2：我们将测试新的HCR如何改变老年人在家庭护理上的支出，使用相同的两个 AIM 1A的数据集。我们将探讨新的HCR对老年人利用的异质作用 并使用HRS数据（包括其广告/ADRD状态）在家庭护理上支出。这 研究直接达到NIH PAS-19-391的总体目的，即，“……为提供的科学见解提供 改善对阿尔茨海默氏病的人的预防，诊断，治疗和/或护理 阿尔茨海默氏病与疾病相关的痴呆症（AD/ADRD）”通过“利用现有数据”。 具有重大的政策影响，因为老年人的规模和预期寿命，尤其是 AD/ADRD的人口以及医疗保健成本继续上升。 1