Harvard Medical School, Boston, Massachusetts.
Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Health Forum. 2021 Sep 17;2(9):e212671. doi: 10.1001/jamahealthforum.2021.2671. eCollection 2021 Sep.
More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms.
To investigate the association between Medicaid home care services and family caregivers' health.
This longitudinal cohort study used data from the 1996 to 2017 Medical Expenditures Panel Survey. Data on all household members were collected in 5 interviews over 2 years. Person-level difference-in-difference models were used to isolate within-person changes associated with new onset of Medicaid home care. The Medical Expenditures Panel Survey longitudinal data sets included 331 202 individuals (approximately 10% excluded owing to loss to follow-up). Adult (age ≥21 years) members of households that contained at least 1 person with limited activities of daily living were included in our study. The analysis itself was performed from March to August of 2020.
New onset of regular (≥1 time per month) Medicaid home care in the household.
Self-rated mental and physical health (planned prior to beginning the study).
The study population was 14 013 adults; 7232 were "likely caregivers," or nondisabled adult coresidents of someone with activities of daily living limitations. Overall, 962 likely caregivers were ever exposed to Medicaid home care in the household; for 563, we observed the onset. Of likely caregivers exposed to Medicaid home care, 479 (50%) were women; 296 (31%) were White non-Hispanic, 309 (31%) were Hispanic or Latinx, and 279 (29%) were Black non-Hispanic individuals, respectively; 326 (34%) had less than a high school education; and 300 (31%) were in or near poverty. Median age of participants was 51 (interquartile range, 39-62) years. New-onset Medicaid home care was associated with a 0.08 standard deviation improvement in likely caregivers' self-rated mental health (95% CI, 0.01-0.14; = .02) measured 1 to 6 months after onset, equivalent to a 3.39% improvement (95% CI, 0.05%-6.33%) over their average preonset mental health. No association with self-rated physical health was found (<0.001 standard deviations; 95% CI, -0.06 to 0.06; = .99).
In this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers.
美国超过 1700 万人为身体或认知能力受限的成年人提供无偿护理。这种护理与更差的身心健康相关，但很少有研究调查公共资助的家庭护理如何减轻这些伤害。
调查医疗补助家庭护理服务与家庭护理人员健康之间的关联。
设计、地点和参与者：这项纵向队列研究使用了 1996 年至 2017 年医疗支出面板调查的数据。在 2 年内的 5 次访谈中收集了所有家庭成员的数据。使用个体内差异-差异模型来隔离与新出现的医疗补助家庭护理相关的个体内变化。医疗支出面板调查纵向数据集包括 331202 个人（约 10%因随访丢失而被排除在外）。包含至少 1 名日常生活活动受限者的家庭中的成年（年龄≥21 岁）成员被纳入本研究。分析本身是在 2020 年 3 月至 8 月进行的。
家庭中定期（每月≥1 次）出现医疗补助家庭护理。
自我评估的心理健康和身体健康（在开始研究之前计划）。
研究人群为 14013 名成年人；7232 人为“可能的照顾者”，即日常生活活动受限者的无残疾核心同住者。总体而言，有 962 名可能的照顾者在家庭中接受过医疗补助家庭护理；对于 563 人，我们观察到了发病情况。在接受医疗补助家庭护理的可能护理者中，479 人（50%）为女性；296 人（31%）为白种非西班牙裔，309 人（31%）为西班牙裔或拉丁裔，279 人（29%）为黑种非西班牙裔；326 人（34%）未接受过高中教育；300 人（31%）处于或接近贫困线。参与者的中位年龄为 51 岁（四分位距，39-62）。新发病例的医疗补助家庭护理与可能照顾者自我评估的心理健康状况改善相关，在发病后 1 至 6 个月内，自我评估的心理健康状况提高了 0.08 个标准差（95%CI，0.01-0.14； = .02），与发病前平均心理健康状况相比，提高了 3.39%（95%CI，0.05%-6.33%）。未发现与自我评估的身体健康有关（<0.001 个标准差；95%CI，-0.06 至 0.06； = .99）。
在这项队列研究中，医疗补助家庭护理与照顾者自我评估的心理健康改善有关，但与自我评估的身体健康的任何短期变化无关。在评估家庭护理计划的社会价值时，政策制定者应考虑对护理人员的溢出效益。
