Community long-term care (CLTC), available in every state, provides funding for services (e.g., personal care, meal delivery, relief for caregivers) for low-income older adults at risk for nursing home placement. Previous research has found that nearly 25% of CLTC clients suffer depression and typically demonstrate low use of mental health services.1 Moreover, when depression goes undetected, there is an increased risk for disability and mortality, particularly among older adults.2,3 In the present study, Hasche and her colleagues examine whether or not the identification of depression influences service authorization in public CLTCs. Authors paid particular attention to competing demands (i.e., total number of health problems, overall level of care needed, cognitive impairment, and number of medications) that had the potential to influence a CLTC worker’s decision to authorize services.
Methods & Sample
CLTC workers approached eligible clients (over 60 years old, English-speaking, were their own legal guardians), of which 1,508 agreed to participate. Phone interviews were conducted with all clients who met depression criteria (n=299) and a random sample of non-depressed older adults (n=315); several participants were excluded for not returning client-release forms, leaving a final analytic sample of 533. Using self-report interview data and case files for CLTC clients between October 2000 and May 2003, researchers determined 1) whether or not the participant’s CLTC worker noted client depression; 2) type and amount of services authorized; 3) competing demands; and 4) sociodemographic variables. Selected sample characteristics are as follows:
- Age Range: 59-95 years (M=72.51, SD=7.98)
- Gender: 75.42% female
- Race/Ethnicity: 26.08% not White
- Marital Status: 24.39% married
- Monthly Income (in dollars): M=738.41 (SD-338.45)
- Depression noted by CLTC in case record: 15.38%
- Competing Demands:
- Number of Health Problems (0-5): M=1.30 (SD=1.21)*
- Overall Level of Care (4-12): M=8.57 (SD=1.28)*
- Cognitive Impairment (0-12): M=2.88 (SD=2.72)*
- Number of Medications (0-22): M=8.44 (SD=4.18)*
Researchers ran three multivariate logistic regressions to determine whether CLTC workers’ depression notation increased the likelihood of service authorization. Each model examined specific services ordered: personal care, homemaker services, and nursing services.
Race, physical health problems, and cognitive impairments were significantly associated with clients being ordered personal care services. Specifically, services were more likely to be ordered for clients who do not identify as White, had more physical health problems, and had fewer cognitive impairments. CLTC workers’ notations of depression were not associated with ordering personal care.
Increased age and rural residency were associated with clients being ordered homemaker services. Services were more likely to be ordered for clients who demonstrated less cognitive impairment and took more medications. CLTC workers’ notations of depression were not associated with ordering homemaker services.
Contrary to the authorization of personal care and homemaker services, notation of depression, as well as number of medications, was significantly associated with the authorization of nursing services. Specifically, CLTC workers were more likely to authorize nursing services for clients who were taking more medications and for whom the worker noted depression.
Though this study focuses on services ordered, as opposed to service utilization, findings indicate that, even when CLTC workers note depression, older adult clients may still have unmet needs (i.e. personal care, homemaker services). The authors suggest implementing standardized depression screenings for CLTC clients to identify depressed older adults and connect them with appropriate services. Moreover, social workers in non-mental health settings may benefit from additional training in identifying depression and familiarizing themselves with relevant community resources.
For More Information
For more information on CLTC and depression among older adults, you can find this full-text article in Social Work Research, Volume 37. For more on Dr. Hasche’s work, visit her GSSW faculty page or DU portfolio.
Hasche, L. K., Lee, M. J., Proctor, E. K., & Morrow-Howell, N. (2013). Does identification of depression affect community long-term care services ordered for older adults? Social Work Research, 37(3), 255-262. doi: 10.1093/swr/svt020
1 Morrow-Howell, N., Proctor, E. K., Choi, S., Lawrence, L., Brooks, A., Hasche, L., et al. (2008). Depression in community long-term care: Implications for intervention development. Journal of Behavioral Health Services and Research, 35, 37-51.
2 Adamson, J. A., Price, G. M., Breeze, E., Bulpitt, C. J., & Fletcher, A. E. (2005). Are older people dying of depression? Findings from the medical research council trial of the assessment and management of older people in the community. Journal of the American Geriatric Society, 53, 1128-1132.
3 Murray, C. J., & Lopez, A. D. (Eds.). (1996). The global burden of disease. A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020 (Vol. 1). Cambridge, MA: Harvard School of Public Health and the World Health Organization.