Patterns and predictors of unmet need among older persons living in residential care homes: The role of personal and facility resources.

Abstract

Although policy makers have paid increasing attention to residential care settings in recent years, few studies have examined patterns and predictors of unmet need among older persons in these settings. This study examined the predictors of unmet need for assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) among older persons living in residential care homes. The study was based on a sample of persons age 55 and over from the Seven-State Study of Board and Care Homes (Denver Research Institute, 1981). The results of the study indicate that persons with a high level of functional limitations were more likely to experience unmet needs for care, suggesting the need for interventions focused on persons in these settings with a high level of functional need. There was also an important relationship between the size of the facility and unmet need. Persons living in larger facilities housing 11 or more persons were significantly more likely to experience an unmet need for assistance with activities of daily living tasks, an effect that was most pronounced among persons in facilities housing 11 to 20 residents that may have difficulty attaining the economies of scale characteristic of larger facilities or the personalized attention of smaller settings. Other personal and facility resources were less strong predictors, though measurement limitations may have affected the results. This study found that persons who received help with ADL and IADL tasks from informal sources such as family or friends were less likely to receive help with these tasks from the staff of the facility than persons who did not receive informal help. In the multivariate context, this significant negative relationship between formal and informal help made it difficult to definitively estimate the unique effects of these two predictor variables on the likelihood of experiencing unmet need for assistance. Future research, using improved measures of help received from formal and informal sources and of unmet need, is necessary in order to further explore these interrelationships and the complex process by which the needs of older persons are addressed in these settings.