Unmet Need: An Acute/Chronic Care Link Unprecedented increases in the elderly population, combined with demographic trends toward higher rates of divorce, smaller families, more people living alone, and more women working suggest that unmet need for care at home among the elderly population with disabilities will escalate in coming decades. In spite of strong preferences to remain at home, current policies discourage funding and use of home care services, reflecting the institutional and acute care bias that dominates public insurance mechanisms. This proposal outlines a comprehensive research agenda to examine the long-term consequences of inadequate care at home, as well as the features and strategies of caregiving networks that are protective of unmet need and its consequences, through analyses of data collected as part of the Second Longitudinal Study on Aging (LSOA II), a longitudinal survey of individuals age 70 and over at baseline (the SOA II). The aims of this study are as follows: 1.) To describe the health, health care and long-term care utilization trajectories over four years in a national sample of elders with limitations in daily living activities at baseline, stratified by the need for and adequacy of help they receive, i.e., no need for help, met need for help, and unmet need for help; 2) To investigate through multivariate modeling the longitudinal health status and acute and long-term care utilization outcomes of unmet need; 3) To identify utilization-related diagnoses that are particularly sensitive to inadequate care in the home, that is, "home care sensitive" diagnoses, (e.g., fractures, pneumonia, dehydration, infection, etc.) for use in targeting and monitoring home care intervention efforts; and 4.) To identify network features that are most strongly related to unmet need at baseline, and to identify caregiving network responses to impaired elders' increasing need that are protective of unmet need and its consequences over time.
