Redefining Substitution: When Does Assistive Technology Take the Place of Personal Care?

Emily M. Agree, Johns Hopkins University
Vicki A. Freedman, Polisher Research Institute
Jennifer C. Cornman, Polisher Research Institute

By substituting for personal care, assistive technology (AT) may reduce older disabled persons’ dependence on personal caregivers. Yet, the nature of substitution between AT and informal or formal care is poorly understood and little attention has focused on which groups are most likely to exhibit this behavior. In this paper we examine these tradeoffs and identify circumstances under which AT takes the place of personal care. Drawing upon a national sample of older persons with underlying disability, we explore four different definitions of substitution. We then jointly model decisions about AT use, formal care, and informal care. We find that in some circumstances AT use is associated with fewer hours of informal care; however AT appears to supplement formal care hours. For two groups – unmarried persons and those with some college education – AT and formal care together seem to offset informal care hours. Implications for the cost of caring for older disabled persons are discussed.