It has been suggested that medical and supportive services must be systematically interwoven to positively affect quality- of –life outcomes of older adults. There are neither conclusive findings on the impact of community based long term care on older people's well-being (Gaugler et al, 2005; Bilsen 2008;Shapiro, 2002), nor conclusive findings on the effect of health care services on the health status of older adults (Golberstein, 2007). We argue that community based services outcome research should be incorporated into existing health care research.
We analyzed the effect of the combined use of health and long term care services on health outcomes among older Americans who live in the community. This research adds to areas of research: the combined use of longitudinal data with a population-based sample in health care and long term care service use.
Using data from the Health and Retirement Study (HRS), a nationally representative dataset, we conducted mixed-effects multiple regression analysis to examine the effect of combined use of individual health service use and the long term care service use on physical health status. We applied random intercept modeling design to account for the dependency inherent in the data due to repeated measurement. An analytic sample (N=499) was drawn from five waves (2000-2008) of the data, focusing on non-institutionalized older adults aged 65 and older who reside in community senior housing that also provided a range of relevant long term care services. For the use of health services, the number of hospitalizations and nursing home stays was measured. Outpatient care and home care service were measured dichotomously. Use of long term care services including group meals, chore service, help with ADLs limitations, and emergency call service, on-site nurse service were measured dichotomously. Physical health status was measured by a morbidity index derived by sum of standardized scores of ADL, IADL, and chronic conditions. Results:
Consistent with health care use studies, the hospitalization (beta=0.46, p<0.01), home care (beta=2.15, p<0.01), and nursing home stay (beta=1.85, p<0.01) were associated with higher levels of morbidity except outpatients care (beta=0.24). A clear trend emerged. The use of health services, combined with long term care services, is associated with the lower level of morbidity: hospitalization when combined with the use of emergency call service leads to lower morbidity (beta= -0.4938, p<0.01), homecare, when combined with the use of meal service leads to lower morbidity (beta= -1.06, p<0.05), using home stay, when combined with the use of chore service leads to lower morbidity (beta= -1.98, p<0.01). Although not significant, chore service and emergency call service, when combined lead to lower morbidity in all health service uses.
Implications: As the first research into an independent effect of long term care services in the context of health service utilization in the community, it provides important information on whether and to what extent long term care services have a beneficial effect on health outcomes when older adult uses health services in the community.