Frail elderly ineligible for Medicaid: How do they manage?

Abstract

This study sought to examine how frail elderly persons meet their needs for care in the community, specifically those persons who are not eligible for means-tested public programs. The study focused on how they arrange to meet their needs on a day-to-day basis and how well these needs are met. Particular factors studied were age, living with someone or alone, financial status, and level of education.;The group studied was a convenience sample of 50 drawn from a certified home health agency in New Jersey. The participants had been discharged in compliance with Medicare guidelines because skilled nursing needs were met. Chronic conditions remained. They were 65 years old or older, needed help with two or more daily activities, and were non-cognitively impaired.;Data was gathered through home interviews with the elders at least four weeks after discharge, utilizing the Adequacy of Care Ratio questionnaire supplemented by additional questions. A qualitative component was included. The quantitative data was analyzed by bivariate analysis.;Findings indicated that elders fared better when they were younger, or had better financial resources as measured by income or liquid assets. Factors of education, and, living alone or with others, did not significantly relate to how well they fared. Additional findings showed that those with more areas of need rated their care significantly lower.;While in general the elders rated their care rather high, insufficient care was reported in certain areas: grooming, toileting, and bathing. Over half of those needing help with grooming and toileting reported they were usually without help. Approximately two fifths of those needing help with bathing were usually without help. These findings suggest "corners are being cut" in these more personal areas of need. Other insufficient care existed in the areas of housekeeping and transportation.;Qualitative findings with themes of loss, worry about health, money and the future suggest that elders experience various degrees of alienation. Implications of the study include a need for systemic changes in long-term care. The exclusion of chronic care from Medicare coverage leaves a gap for those who "fall between the cracks" in our welfare system.