Informal Caregiver Assistance among Adults with Cardiovascular Disease in Ohio

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Informal Caregiver Assistanceamong Adults with
CardiovascularDisease in Ohio

• Deborah A. Levine, MD, MPH
• Assistant Professor of Medicine
• Division of General Internal Medicine
• Division of Health Services Management Policy
• The Ohio State University

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Co-Investigators

• Sudeep Karve, PhD
• Eric Seiber, PhD
• Al Dembe, ScD
• Andrew Slivka, MD
• Bo Lu, PhD

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Cardiovascular Disease (CVD) in Ohio

• Leading cause of death in the US and Ohio
  accounting for 35-40 of deaths
• Prevalence is increasing in US and Ohio
• Self-reported prevalence of CVD in Ohio adults
  (OFHS 2008)
• Heart attack (5.4)
• Coronary heart disease (6.3)
• Stroke (3.5)
• Congestive heart failure (3.0)
• Effect of CVD prevalence on use and costs of
  health care and non-health care services are
  unknown

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CVD and Caregiver Assistance

• CVD associated with increased disability, need
  for home and community-based services and
  caregiver assistance, even long-term
• Caregiver assistance may have adverse effects on
  caregiver, health care system, and employers
• Caregiver assistance important for adult Medicaid
  recipients with CVD
• Amount and cost of caregiver assistance for
  adults with CVD in Ohio are unknown

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Study Aims

• To assess current prevalence of informal
  caregiver assistance for adults reporting a
  history of CVD for the state of Ohio.
• To determine whether caregiver assistance for
  adults with CVD is higher among the four priority
  CVD populations for the state of Ohio men,
  African-Americans, Appalachians, and those living
  in poverty.
• To estimate the cost of caregiver assistance for
  adults with CVD in Ohio using 2007 US Bureau of
  Labor Statistics wage rates.
• To estimate the amount and cost of caregiver
  assistance for adults with CVD in Ohio who are
  Medicaid recipients.

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Methods Patient Population

• Ohio Family Health Survey 2008
• 7,040 adults aged 18 years with history of CVD
  (heart attack, coronary heart disease, stroke or
  congestive heart failure (CHF))
• 42,681 adults aged 18 years without CVD
• Compared amount of self-reported informal
  caregiver assistance, measured in mean hours per
  person per month, by CVD status

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Methods Outcome Definition

• Caregiver assistance currently need any of the
  following types of assistance because of health
  problems
• Assistance with personal care (hygiene, feeding)
• Domestic assistance (housekeeping,
  transportation)
• Help with household maintenance (painting, yard
  work)
• Social or emotional support (companionship,
  recreation)
• Coordinating health care (making medical
  appointments)
• Assistance managing financial affairs
• Other kinds of assistance
• How many hours of assistance do you currently
  require on average for the types of assistance
  that were just mentioned?

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Methods Analysis

• Two-part regression model
• First part logistic regression models estimated
  the probability of reporting informal caregiver
  assistance for respondents with and without CVD,
  before and after adjusting for covariates
• Second part ordinary least squares regression
  examined the association of CVD category with
  natural logarithm of informal caregiver
  assistance hours per month for respondents who
  reported any informal caregiver assistance
• Combined results of two models to obtain an
  estimate of the average effect of CVD on monthly
  hours of informal caregiver assistance required
  per person (unconditional effect of CVD)
• Regression model results were retransformed to
  hours
• Statistical analysis STATA
• Complex sampling design
• Weighted results

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Methods Regression Model
Co-morbidity included hypertension, diabetes,
cigarette smoking
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Methods Cost Analysis

• Used market price of equivalent service/worker to
  estimate opportunity cost for the time of an
  informal caregiver
• Estimated the annual cost of informal caregiver
  assistance attributable to CVD
• Multiplied the adjusted monthly hours of informal
  caregiver assistance per person attributable to
  CVD by the 2007 US Bureau of Labor Statistics
  median wages for a home health aide (9.15/hour)
• Multiplied by 12 (months per year)
• Multiplied by the population estimate of the
  number of adults Ohioans with CVD in 2008
• Repeated analysis for recipients of any Medicaid
  and recipients of Medicaid and Medicare

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CVD Prevalence in Ohio, Overall and by Age Group,
2008
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Characteristics of Adults with CVD in Ohio, 2008
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Characteristics of Adults with CVD in Ohio, 2008
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Characteristics of Adults with CVD in Ohio, 2008
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Percentage of Adults with Cardiovascular Disease
(CVD) Reporting Informal Caregiver Assistance in
Ohio, Overall and by Age, 2008
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Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio
by Type of Cardiovascular Disease, 2008

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Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio,
by Gender and Age, 2008
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Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio,
by Race/Ethnicity, 2008
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Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio,
by Region, 2008
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Percentage of Adults with Cardiovascular Disease
Reporting Informal Caregiver Assistance in Ohio,
by Poverty Level, 2008
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Cost of Informal Caregiver Assistance
Attributable to Cardiovascular Disease (CVD)
among Adults in Ohio, 2008
Adjusted for age, gender, race/ethnicity,
region, poverty level, education, marital status,
number of adults in household, health insurance,
co-morbidity, health status, and number of
hospitalizations in last year.
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Cost of Informal Caregiver Assistance
Attributable to Cardiovascular Disease (CVD)
among Adults in Ohio, 2008
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Adult Medicaid Recipients with CVD

• Approximately 120,000 adults with CVD are
  recipients of Medicaid of whom 65 report
  informal caregiver assistance.
• The average yearly cost of informal caregiver
  assistance attributable to CVD was 694 per
  person.
• Approximately 71,000 adults with CVD are
  recipients of Medicaid and Medicare of whom 65
  report informal caregiver assistance.
• The average yearly cost of informal caregiver
  assistance attributable to CVD was 1471 per
  person.

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Type of Informal Caregiver Assistance among
Adults Reporting Help with Only One Activity
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Limitations

• Self-report of informal caregiver assistance may
  underestimate infrequent assistance
• Self-report of CVD
• Severity of CVD, onset of CVD, quality of CVD
  care, dementia, rehabilitation cannot be assessed
• Limited to community-dwelling adults
• No direct measure of caregiver assistance by
  type, provider, or disease (due to CVD or other
  condition)
• Cost estimates used median hourly wage for a home
  health aide but some informal care may or may not
  be performed by a home health aide (e.g.,
  social/emotional support)

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Conclusions

• Informal caregiver assistance for adults with CVD
  in Ohio is substantial and costly.
• Approximately 50 of community-dwelling adult
  Ohioans with CVD report informal caregiver
  assistance.
• Priority CVD populations reported more informal
  care
• Non-Hispanic blacks
• Hispanics
• Appalachians
• Adults living in poverty
• Stroke and CHF had highest rates of informal
  care.
• Estimated 2008 annual cost of informal caregiver
  assistance attributable to CVD was 563 million
  for Ohio.

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Policy Implications

• Expand or more efficiently allocate resources to
  provide home and community-based care.
• Assess availability and quality of current
  resources and programs to provide home and
  community-based care, particularly for the
  elderly.
• Develop and implement programs to identify care
  needs.
• Focus on vulnerable populations (non-Hispanic
  blacks, Hispanics, those living in Appalachia,
  those living in poverty, the elderly, women) who
  may require ancillary health care and social
  services.
• Coordinate home-based and community resources
  across agencies.
• Streamline the applications for services by
  patients and their caregivers.

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Policy Implications

• To address caregiver burden
• Ensure adequate availability and duration of
  family medical leave for employed caregivers.
• Increase the availability and health insurance
  coverage of respite care.
• Ensure the availability and health insurance
  coverage of counseling and support services.

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Acknowledgements

• Melissa Senter, MA, MPH
• Rosemary Duffy, DDS, MPH
• Barry Jamieson, MA
• Find full report at http//grc.osu.edu/ofhs

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