Effects of EITC on Formal Long-Term Care for Older Adults with and without AD/ADRD

抽象的。超过70%的65岁或65岁以上的老年人需要基本护理人员的帮助 在他们一生中的某个阶段，有600多万美国老年人患有阿尔茨海默病 和阿尔茨海默病相关痴呆(AD/ADRD)，需要比他们的 没有AD/ADRD的对应者。在需要帮助的老年人中，约有三分之一接受了正式的帮助 家庭或机构中的提供者。这些正规的长期护理(LTC)提供者的工资很低，而且停滞不前 福利很少，这导致正规护理提供者严重短缺和高流失率。 对于低收入的正式照顾者来说，情况尤其糟糕。劳动所得税抵免(EITC)是一种税收 为中低收入工薪家庭提供的信贷，是规模最大、最有效的反贫困措施之一 在美国的项目。EITC可能会影响老年人的护理，因为它鼓励工作、补充 增加收入，改善低收入者的身心健康和整体福祉。然而， 尽管有大量关于EITC的文献，但人们对其对老年人正规护理的影响知之甚少。我们建议 要通过利用EITC中大量看似外生的政策变化来填补这一知识缺口，请访问 过去20年的联邦和州水平，并使用差异差异和事件研究 方法和具有全国代表性的大型数据集(健康和退休研究和当前人口 调查)考察EITC对正规医疗服务的提供和利用的影响 包括照顾者的AD/ADRD状态的维度。具体来说，我们将追求以下目标：目标 #1：我们将测试EITC如何为最有可能受到影响的人改变正式LTC的供应 EITC--18岁低收入个人----使用当前人口调查。目标2：我们将测试 EITC改变了老年人对正规长期TC的使用和自付支出，包括住房和 机构护理，使用来自健康和退休研究(HRS)的公共和受限数据。目标#3 (探索性)：根据前两个目标的结果，我们将检查 正式的长期护理导致使用HRS数据的老年人利用的非正式护理的强度和类型发生变化， 鉴于正式和非正式的LTC可以替代或补充老年人。这项研究直接 解决国家老龄问题研究所的目标，即“找到显著改进且经济高效的方法 减少照顾者、家庭和患者的压力，提高老年人应对慢性病的能力。 这项研究的发现将具有重大的政策意义，因为老年人的体型和预期寿命 成人人口，特别是患有AD/ADRD的人口和保健费用继续上升，使 医疗保健系统面临前所未有的压力。我们还将向决策者提供有价值的信息。 有兴趣设计有效的人口层面政策来支持卫生保健工作者，特别是 弱势的低收入医护人员。 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. About one-third of older adults who require assistance receive help from formal providers at home or an institution. These formal long-term care (LTC) providers have low and stagnant wages with few benefits, which have resulted in a severe shortage of and a high turnover rate for formal care providers. The situation is particularly dire for low-income formal caregivers. The Earned Income Tax Credit (EITC) is a tax credit for low- and moderate-income working families and is one of the largest and most effective anti-poverty programs in the US. The EITC could impact care for older adults because it encourages work, supplements incomes, and improves physical and mental health and overall wellbeing for persons with low incomes. However, despite a vast literature on the EITC, little is known about its effects on formal care for older adults. We propose to fill this knowledge gap by leveraging a large number of plausibly exogeneous policy changes in the EITC at the federal and state levels in the past two decades and using difference-in-differences and event-study approaches and large, nationally representative data sets (Health and Retirement Study and Current Population Survey) to examine the effects of the EITC on formal care provision and utilization along several important dimensions including the care recipients’ AD/ADRD status. Specifically, we will pursue the following aims: Aim #1: We will test how the EITC has changed the supply of formal LTC for those most likely to be affected by the EITC—low-income individuals aged 18-64—using the Current Population Survey. Aim #2: We will test how the EITC has changed older adults’ utilization of and out-of-pocket expenditures on formal LTC, including home and institutional care, using the public and restricted data from the Health and Retirement Study (HRS). Aim #3 (exploratory): Depending on the findings from the first two aims, we will examine whether estimated changes in formal LTC lead to changes in the intensity and type of informal care utilized by older adults using the HRS data, given that formal and informal LTC could be substitutes or complements for older adults. This study directly addresses the goal of the National Institute on Aging to “Find significantly improved and cost-effective ways to reduce caregiver, family, and patient stress and improve older adults’ ability to cope with chronic disease”. 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, putting unprecedented pressure on the health care system. We will also provide valuable information to policymakers interested in designing effective population-level policies to support health care workers, especially the most vulnerable low-income health care workers. 1