Use of unpaid and paid home care services among people with HIV infection in the USA

This paper examines utilization of paid and unpaid home health care using d ata from a nationally representative sample of HIV-positive persons receivi ng medical care in early 1996 (N = 2,864). Overall, 21.0% used any home car e, 12.2% used paid care and 13.6% used unpaid care. Most (70.0%) users of h ome care received care fi om only one type of provider. Substantially more hours Of unpaid than paid care were used. We also found evidence of a stron g association between type of service used and type of care provider: 62.4% of persons who used nursing services only received paid care only; convers ely, 55.5% of persons who used personal care services only received care on ly from unpaid caregivers. Use of home care overall was concentrated among persons with AIDS: 39.5% of persons with AIDS received any home health care , compared to 9.5% of those at earlier disease stages. In addition to havin g an AIDS diagnosis, logistic regression analyses indicated that other need variables significantly increased utilization; a higher number of HIV-rela ted symptoms, lower physical functioning, less energy, a diagnosis of CMV a nd a recent hospitalization each independently increased the odds of overal l home care utilization. Sociodemographic variables had generally weak rela tionships with overall home care utilization. Among users of home care, non -need variables had more influence on use of paid than unpaid care. Both pa id and unpaid home health care is a key component of community-based system s of care for people with HIV infection. The results presented in this pape r are the first nationally representative estimates of home care utilizatio n by persons with HIV/AIDS and are discussed with reference to policy and f uture research.