Living Alone and Patient Care Experiences: The Role of Gender in a National Sample of Medicare Beneficiaries

Abstract

Background: Seniors who live alone are a large, growing population with poorer health outcomes. We examine the little-studied health care experiences and immunizations of older adults who live alone.

Methods: We use regression-based case-mix adjustment to compare immunizations and health care experiences of 325,649 adults aged 65 and older who lived alone to those who did not, overall and by gender and health status, using nationally representative data from the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Outcomes were five global care ratings (health plan, drug plan, doctor, specialists, all care), six composite care measures (getting needed care, getting care quickly, doctor communication, customer service, getting needed drugs, getting information from drug plan), and two immunization measures (influenza, pneumonia).

Results: About 30.3% of respondents lived alone. Women, older beneficiaries, and low income (Medicaid eligible) beneficiaries reported living alone at substantially higher rates than their counterparts. Care experiences for 8 of the 13 measures were significantly worse for those who lived alone than for others. The association differed significantly in magnitude by gender for 10 measures, with larger average differences for men. The largest disadvantages for those living alone were for immunization measures (eg, influenza -6 percentage points, for men living alone vs other men). The disadvantages of living alone were not consistently greater for those in worse health.

Conclusions: Living alone is associated with worse care experiences and immunization, especially for men. Health plans should target quality improvement and outreach efforts to beneficiaries who live alone, especially men.

Keywords: Gender; Living arrangements; Medicare; Patient experience.