SOCIAL SUPPORTS AS A DETERMINANT OF COMMUNITY-BASED CARE UTILIZATION AMONG REHABILITATION PATIENTS

Objective. We determine the extent to which noninstitutionalized long- term care patients receive assistance from family members and friends, and evaluate the effect of this assistance on use of outpatient rehab ilitative and personal care services. Data Sources and Study Setting. Over 12 months, primary data were collected from 289 patients in nonin stitutional settings after inpatient rehabilitation at three Boston-ar ea rehabilitation hospitals. Data on patients' acute and rehabilitativ e stays were obtained from medical record reviews. Patients provided p rimary data on sociodemographics, living arrangements, social supports , functional status, health behaviors, life events, and use of outpati ent services during the study period. The latter was verified and serv ice charge data obtained from the care providers. Study Design. The st udy was longitudinal and observational. Patient-provided information w as obtained at one, six, and twelve months postdischarge. Analytic Met hods. Multivariate Tobit regression was used to evaluate the effect of social supports on patients' use of rehabilitative and personal care services, controlling for sociodemographics and functional status. Ser vice use was measured as charges incurred during the 12-month study pe riod. Principal Findings. Results confirm the primary role of family a nd friends in providing daily personal care and identify the availabil ity of that support as a key determinant of expenditures on community- based personal care services. Social supports do not predict outpatien t rehabilitative service use. Conclusions. Differing eligibility crite ria seem appropriate for outpatient rehabilitative and personal care s ervices. The current emphasis on functional status in determining reha bilitative service eligibility appears appropriate; but we find that c onsidering patients' social supports would be both meaningful and appr opriate in determining personal care service eligibility. This approac h would avert the expense of making personal care services universally available, while facilitating assistance for patients whose functiona l and social status put them at increased risk of institutional placem ent.