Home-Based Care Outcomes: Does the Care Provider Matter?

Area of Science:

• Gerontology
• Health Services Research
• Sociology of Health

Background:

• Long-term home care predominantly relies on unpaid family/friend caregivers, with increasing use of formal (paid) care.
• The comparative benefits of different care provider combinations (family only, formal only, both) on recipient outcomes are not well understood.
• Factors influencing care choices may also impact health outcomes, creating endogeneity issues in causal analysis.

Purpose of the Study:

• To estimate the causal impact of different home-based care combinations on mental and physical health outcomes.
• To compare outcomes for recipients receiving family care only, formal care only, and a combination of both.
• To address endogeneity in care provider selection using an instrumental variables strategy.

Main Methods:

• Utilized data from the Health and Retirement Study (HRS) spanning 2002-2018.
• Employed an instrumental variables strategy, using family structure as instruments for formal and combined care.
• Analyzed three care combinations: family only, formal only, and both formal and family care.

Main Results:

• Receiving both formal and family care significantly improves self-rated health, mobility, and reduces depression compared to family care alone.
• Receiving formal care exclusively showed no significant difference in outcomes compared to family care only.
• Findings remained robust across various sensitivity analyses and subsamples.

Conclusions:

• A combination of formal and family care is superior to family-only care for improving older adults' health and well-being.
• Formal care alone does not appear to offer additional benefits over informal care in the studied outcomes.
• These findings inform strategies for delivering person-centered, high-quality long-term care.