EFFECT OF FORMAL HOME CARE SERVICES ON CAREGIVER BURDEN

该提案将使人们更好地了解社区中低收入和体弱老年人的家庭护理动态，并测试一个项目招收符合医疗保险和医疗补助资格的个人来支持非正式护理的能力。拟议的研究将在明尼苏达州老年健康选择（MSHO）计划的背景下实现这些目标，这是一个医疗保险和医疗补助资金的综合医疗保健计划，针对“双重资格”的老年人（即根据年龄有资格获得医疗保险，根据其社会经济地位有资格获得医疗补助）。本研究使用来自家庭和社区MSHO注册者和两组未注册MSHO的匹配对照的调查数据来检验以下具体目标：测试通过MSHO计划覆盖的双重合格个人是否减轻了家庭照顾者的负担，与没有参加MSHO的人相比。2. 确定家庭照护者负担是否随着家庭照护服务（包括家庭健康照护服务）的数量和频率的增加而减轻，以及正规家庭照护提供者技能水平的提高是否会降低照护者负担。3. 确定正规护理的使用是否减轻了MSHO和非MSHO组患者的家庭照顾者负担，以及MSHO对家庭照顾者负担的影响是否是正规护理使用的函数。为了解决这些研究目标，首席研究员将使用社会支持概念框架来研究社区和家庭护理服务如何缓解压力源的影响，如照顾者损伤对照顾者负担的影响。本文将使用普通最小二乘回归和结构方程模型进行分析。

This proposal will provide a better understanding of the dynamics of family caregiving to low income and frail elderly individuals living in the community, as well as to test the ability of a program enrolling Medicare- and Medicaid-eligible individuals to support the role of informal care. The proposed research will accomplish these objectives within the context of the Minnesota Senior Health Options (MSHO) program, a Medicare- and Medicaid-capitated, integrated health care program for seniors who are "dually-eligible" (i.e. eligible for Medicare based on their age and eligible for Medicaid based on their socioeconomic status). This study uses data from a survey of home and community based MSHO enrollees and two sets of matched controls not enrolled in MSHO to examine the following specific objectives: 1. To test whether coverage of dual eligible individuals through the MSHO program reduces family caregiver burden, in comparison to those not enrolled in MS HO. 2. To determine if family caregiver burden decreases with increased amount and frequency of home care services, including home health care services, and whether increased skill level of the formal home care provider will result in lower levels of caregiver burden. 3. To determine whether formal care use decreases family caregiver burden for patients in the MSHO and non-MS HO groups, and whether the impact of MSHO on family caregiver burden is a function of formal care use. To address these research aims, the Principal Investigator will use a social support conceptual framework to examine how community and home care services moderate the effect of stressors such as care recipient impairment on caregiver burden. Ordinary least squares regression and structural equation modeling will be used to carry out the analyses.