Investigating differences among older adults' access to specialized rehabilitation services

The purpose of this study was to (a) describe rehabilitation in-patients aged 65 and older who received specialized occupational therapy home evaluation services and (b) examine these data for evidence of inequalities based on patient gender, race, age, and health insurance status. An archival review was conducted of all in-patient admissions (2,767) to a large urban rehabilitation hospital who were 65 years and older and eligible to receive a home evaluation. Logistic regression was used to predict the likelihood of receiving an occupational therapy home evaluation. Analysis showed that 9.7% of subjects received an in-home evaluation and those who did had significantly longer rehabilitation hospital stays (p < 0.0001) and were significantly more dependent at discharge as measured by the Functional Independence Measure (p < 0.0001) than those who did not. We found no evidence of inequalities on the basis of gender, race, age, and health insurance type after controlling for the level of functional independence of patients. Although this study found little evidence of inequalities, it does raise several critical policy questions including "How many rehabilitation in-patients should receive a home evaluation?" and "How should rehabilitation services be allocated?"