The Role of Spousal Characteristics on the Use of Formal Long-Term Care of Elderly Couples in the United States.

摘要

In the United States, the last decades have witnessed a steady increase in the percent of formal long-term care (nursing home care and paid home health care) uses. Specifically, it is shown that the percent of elderly couples, who use formal long-term care is much lower than that of single-living elderly to use formal long-term care. However, it has not been fully understood what factors determine the use of formal long-term care for elderly couples.;Different from the previous studies, I scrutinize not only own individual factors but also spousal characteristics in terms of spouses health conditions, which may determine the use of formal long-term care of elderly couples. Detailed health conditions of spouse are considered; spouse's health dynamics and diagnosed illness by doctors. In addition, I carefully consider two different cases, according to the identity of the principal decision-maker regarding uses of formal long-term care: (i) An individual who needs long-term care decides formal long-term care uses himself/herself, and (ii) the spouse of the individual decides the individual's formal long-term care utilization.;Models are estimated using multinomial logit specification using data from the Health and Retirement Study. Results suggest that the age, education level, the individual's health conditions and Activities of Daily Living ("ADL") changes are key factors that strongly affect the decision for utilization of formal long-term care for the elderly couples. When the individual has more disabilities in daily living, or has illnesses such as cancer, diabetes, stroke, psychological problem, or memory problem, he/she is more likely to use formal long-term care. I have also found that the spouse's health conditions, such as Instrumental Activities of Daily Living ("IADL"), ADL, diabetes, cancer or psychological problems affect the formal long-term care of the individual.;This study shows that the spouse has an important effect on the individual's decision-making, regardless of who is ultimately in charge of that decision. However, when the group is classified according to `decision maker', the role of the spouse in the decisions regarding the individual's utilization of formal long-term care is more clearly understood.