By the Heartland Center on Aging, Disability, and Long Term Care, continued –

Lack of Assistance for functional Limitations: Two distinct measures gauge future and current need for functional assistance. The first includes elders who report a current functional difficulty but who receive no help for that limitation. A second probe asks persons who are currently assisted if such help is sufficient.

• Overall, 16% of the total survey population is not assisted with at least one ADL or IADL difficulty.
• Of all persons with one or more ADL limitations, 42.4% receive no assistance. Similar proportions of those with one or more IADL limitations are unassisted. The proportion of ADL unassisted elders in Illinois is twice that reported in the national studies cited earlier.
• The second most common ADL, bowel and bladder difficulties, which affects some 4% of all those over age 60, is far less frequently assisted than any other ADL impairment. Nearly half of those listing this condition receive no help.
• Respondents meeting federal poverty or near-poverty guidelines are twice as likely to report “no help” with one or more functional impairments than persons with more incomes.
• 24% of ADL impaired elders over age 75 lack assistance for one or more of their ADL impairments, as compared to 13% of those age 60-74.
• The most frequently listed IADL problems (heavy chores and housework) also are those least likely to receive assistance.

Assistance for Functional Limitations: Family and friends are the primary source of all assistance of the impaired elderly. 42% of the ADL impaired elderly receive no help, another 35% are helped exclusively by family and friends, 13% are assisted only by service agencies, and 6% use combined care giving sources. Of Illinois elders who get ADL help, half are assisted for one ADL, 20% get help for 2 ADL impairments, and 30% are helped for 3 or more limitations.

Trends in Illinois elders who receive no help or who rely exclusively on informal helpers for their IADL limitations are similar to those seen for ADL limitations (41% and 32% respectively.) However, nearly 21% of all those over age 60 are helped by formal agency services for IADL problems. In other words, family members are clearly the care givers of choice for personal care, whereas non-family helpers are accepted for chore-related help.

• Over 90% of those relying exclusively on informal assistance live in couple or multi-person households. This appears to be a greater rate than implied by other national surveys.
• Elders who live alone receive some 40% of all agency and combined family-agency help. Only 13% of ADL assisted persons who live alone rely exclusively on informal care while 87% are helped by agency or combined resources. This is the case even though nearly all have family within one hour’s travel time. The availability of agency services is clearly a factor in retaining single elders in their own homes.
• Poverty status, race, and rural-urban residence were not strongly related to whether an elder relied exclusively on informal care givers. However, the ADL assisted elderly who live in multi-person households are principally minority members and poor.
• Two-thirds of persons age 60-74 with 3 or more ADL impairments are helped exclusively by family and friends, one third get help from formal and combined sources. In contrast, persons assisted with incontinence problems are evenly divided between formal (45%) and informal (55%) sources. Thus, in addition to receiving less overall assistance, those with incontinence problems are more likely to use non-family assistance than are persons with even more severe ADL impairments.
• The assistance among IADL impaired elderly is 55% on formal sources and 45% who rely exclusively on informal sources.

Frequency of Assistance for Functional Impairments: The frequency of help received depends a great deal on the type of functional limitation. For example, one half of those over age 60 who receive help with any ADL are assisted on a daily or more frequent basis. Once an elder receives ADL help, the assistance reflects a regular and major investment of family time.

• Conversely, less than 15% of either age group (60-74, 75+) used IADL help on a daily basis. Of those with only out-of-home IADL limitations, assistance needs were helped only on a weekly basis, and 40% were helped even less frequently.
• Impairment in both ADL and IADL activities doubles the chance that daily-level care will be used for both types of limitations. In fact, dual ADL-IADL impairment is more strongly associated with use of daily care than is the age of the elder.

Unmet Needs for Those Now Assisted: The need expressed by elders for additional IADL help far surpassed that reported for additional help with ADL care. While similar proportions of elders rely exclusively on informal care for either ADL or IADL limitations, ADL impairments are often assisted on a daily basis, whereas IADL chores and activities can often be postponed if help is not immediately available.

Less than 1% of the total population over age 60 report current help for any ADL impairment is insufficient. However, among those persons already receiving help, 9% report need for additional ADL help, and over 60% require more IADL help.

A further 26% do not report a current perception of need, but they now receive daily assistance from family for both ADL and IADL impairments. This latter category does not double-count those who perceive a need for greater care, but taps those who may be at risk of institutionalization if family care givers cannot continue in their current role. White respondents are nearly 3 times as likely as minorities respondents to receive such intensive informal care.

• Minorities report 1.5 to 2 times the level of unmet ADL needs than whites. Respondents from multi-person households also report greater unmet need, especially for help with toileting, incontinence, and bathing. These findings again support the greater functional disability of minority elderly, the greater disability of elders who live with family members, and the possibility that family care givers may still be employed.
• Over half of the elders over age 60 who rely on family assistance for IADL help report they need further IADL assistance. In contrast, only 7% of similar-aged ADL impaired elderly who rely on family help reported unmet ADL needs.
• Among persons who rely primarily on agency or combined resources for IADL assistance, 84% require more help, as do 42% of those who use such resources for ADL assistance. As minorities are more frequently users of agency-provided services, unmet needs may reflect an insufficient match in type or frequency of help to those with the greatest functional and chronic health problems.

Service Use Patterns: A number of Aging-Network services were probed in the survey. The respondents indicated either current use or current need for themselves and sequentially, for other household elders. These include congregate and home delivered meals, transportation, home nursing and therapy (home health care), education, fitness, legal services, support for caregivers >and adult day service.

• The most frequently reported services used by respondents includes senior centers (15%), attorney services (11%), senior transportation (5%), and congregate meals (4.4%).
• Minorities often outnumber whites in both their current use, and in their expression of need for Aging-Network services. For example, minorities are twice as likely to use home nursing and therapy services, and 3 times more likely to use case management help than are whites.
• The success of targeting of services to the poor is also evident in service utilization rates, where two-thirds to three-quarters of the recipients of home nursing and therapy, and case management, and nearly one half of those using congregate meals fall below 125% of federal income poverty guidelines. Furthermore, nearly equal numbers of poor and near-poor respondents cite a need for these services.
• Senior congregate meals and home delivered meals are used by those who live alone twice as often as by other households.
• Home delivered meals, respite, and adult day service needs are expressed 2 to 4 times more often by multi-person households, again reflecting the greater impairment levels of their elders.
• Persons hospitalized in the previous year used 5 times the levels of home nursing and therapy and twice the rate of home delivered meals and case management, as did persons who were not hospitalized. Equal or greater numbers of recently hospitalized respondents indicate they currently need these services, as well as adult day service, respite, and support services.
• Of those needing help with transportation, 44% use it primarily for visiting or community-related activities, 5% use it primarily for appointments or grocery shopping, and 50% have multiple transportation needs.

Service Awareness: Senior centers, meal services, and home nursing are recognized as “existing in the community” by 70% or more of all respondents. Recognition was nearly as high for senior transportation, tax relief programs, utility assistance, and legal and counseling help (cited by 50-60%).

• Least recognized services include adult day service, respite and care giver support, friendly visitors, and telephone reassurance, which were known to 33% or fewer respondents.
• Service recognition coincides with demographic groups which use certain services more frequently. Minorities recognize and more frequently use home services and senior center related services. Whites contrarily, are more familiar with adult day service, respite, counseling, attorney services, and fitness programs.
• While care giving households are more likely to recognize home delivered meal services than non-care givers, they hove no greater recognition of those services designed to give them support in their care giving role, such as counseling or respite care.
• Senior centers are the most frequently cited source of where to receive information on services.
• Women respondents of all ages are nearly twice as likely as men to list any of the community sources of information. Minorities rely somewhat on family, social workers, the clergy, and television for information on services than do whites.

Use of Medical Services: Surprisingly, elders aged 60-74 do not differ significantly in their reported hospitalizations as those age 75 or older. As expected, rates of hospital use in the previous year are higher among the poor and near-poor.

• Less than 1% of the respondents over age 60 entered a nursing home in the previous year and had been released back to the community. Returning long-term care patients are 3 times more likely to be poor, and 4 times more likely to be age 75 or older, than are non-patients. Of these returning patients, 51% report dual ADL and IADL limitations.

Quality of Life Issues: Overall, quality of life can be viewed through the responses of individuals to broad questions about their satisfaction with life as a whole, their current housing situation, levels of social involvement, mental health, and rate of perceived victimization.

• The majority (87.6%) of elders surveyed have no ADL limitations and report satisfaction with their quality of life. Satisfaction decreases with as elders report increasing numbers of ADL and/or IADL limitations.
• The majority of couples, elders living alone, and those living in multi-person households describe themselves as satisfied.
• As their financial condition had worsened over the last 3 years, less elders are satisfied than those who indicated their financial condition to be the same or better. Perception about life satisfaction may also be influenced by the elders inability to apply for and receive financial assistance.
• There is a weak but significant relationship between reported age discrimination, crime victimization, and financial exploitation and decreased levels of satisfaction. There is a stronger relationship between dissatisfaction and physical or emotional abuse.
• A weak relationship exists between levels of participation in community activities and lower levels of satisfaction.
• Satisfaction with housing is attributable to available financial resources.

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