Disparities between younger and older adults in access to Personal Assistance Services (PAS)

Despite an aging population, half of adults needing PAS are younger adults (YA) ages 18-64, based on the 2007 American Community Survey and the 2005 Survey of Income and Program Participation. Analysis of the 1994-97 National Health Interview Survey on Disability, Phase II, shows, among adults needing PAS, only 14 percent of YA received paid help compared to 36 percent of older adults (OA; OR=0.3 95%CI 0.26-0.34). That difference remains large after controlling for health conditions, severity of disability (using an IRT-validated I/ADL scale) and demographic and other factors. Some of this difference may reflect preferences for informal help. But overall, YA fare worse than OA. YA have a higher rate of unmet needs in I/ADL (OR=1.24, 95%CI 1.1-1.4), especially mobility, and higher unmet need for paid personal attendants (OR=4.7 95%CI 3.1-7.1). YA have higher rates of falls and contractures, and are less satisfied with the amount and quality of PAS than OA (OR range 1.5-1.9). YA are more likely to have a family member reduce employment to provide help (OR=3.2, 95%CI 2.6-3.8). The greater reliance of YA on family members is a disparity that appears associated with greater unmet need, lower satisfaction, more secondary conditions, lower ability to pay, and greater impact on family members employment than OA. Public policy should strive to improve access of adults of all ages to paid PAS, as called for by Article 19 of the UN Charter on the Rights of PWD, the ADA, and legislation such as the Community Choice Act.