The Economics of Long-Term Care
Paper Session
Sunday, Jan. 7, 2024 1:00 PM - 3:00 PM (CST)
- Chair: Yong Suk Lee, University of Notre Dame
The Demand for Skills Training among Medicaid Home-Based Caregivers
Abstract
Medicaid spends nearly 100 billion dollars annually on home and community-based care for the disabled. Much of this care is provided by personal care aides, few of whom have received training related to the services they provide. We conducted a randomized controlled trial to estimate their demand for training. We find that 13 percent of these caregivers complete training without an incentive. Paying the caregivers four times their hourly wage increases training completion by roughly nine percentage points. Welfare analysis suggests that shifting resources towards training programs is likely to provide greater welfare benefits than a cost-equivalent wage subsidy.Vertical Integration and Agency: Evidence from the Long-Term Care Market
Abstract
This paper examines how vertically integrated (VI) care managers, agents who develop a "care plan" on behalf of frail older people, select services and providers for the elderly. We find that VI care managers tend to include services provided by co-owned providers and exclude services not provided by co-owned providers. We also find that VI care managers refer clients to co-owned providers at the expense of their clients' travel costs. We also examine how VI affects the health outcomes of frail older people with respect to disability and dementia status.Robots in Nursing Homes
Abstract
How do staffing and productivity in nursing homes change with robot adoption? To probe this question, we conducted surveys of nursing homes in early 2020 and 2022 in Japan, linked to administrative data on nursing home characteristics. We separately examine three types of long-term care robots: monitoring and communication robots; mobility robots that assist residents with walking and bathing; and transfer robots that assist caregivers in lifting, repositioning, and transferring bed-ridden residents.Analysis of the resulting facility-level panel data reveals that robot adoption is accompanied by an increase in staffing, with the relationship strongest for part-time careworkers. The complementarity between robot adoption and staffing is primarily driven by monitoring/communication robots. For monitoring, communication, and transfer tasks, the share of tasks performed by robots increases with the adoption of the respective type of robot, leading to corresponding reduction in careworker effort on those tasks. Robots also appear to mitigate the problem of high careworker turnover, especially exits.
Examining proxies for productivity, we find that monitoring and transfer robots are positively related to the number of residents receiving care, facility total revenue, and the waitlist (excess demand). Furthermore, use of restraints and pressure ulcer cases decrease with robot adoption, especially monitoring robots, suggesting improvements in quality of care. However, mobility robots are associated with more falls.
Overall, our findings imply that robot adoption changes the tasks performed by caregivers, complements direct-care staff, and can potentially improve productivity. However, different robots differ in complementarity depending on the primary user or beneficiary (i.e., caregiver or frail resident). Moreover, some robots may raise safety concerns for users not well trained to operate them.
Discussant(s)
Alan Sorensen
,
University of Wisconsin
Nicole Maestas
,
Harvard University
Momotazur Rahman
,
Brown University
Anita Mukherjee
,
University of Wisconsin
JEL Classifications
- I1 - Health
- J4 - Particular Labor Markets