UNDERSTANDING RACE DIFFERENCES IN LONG-TERM CARE

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The provision of long-term care to disabled older people continues to be a major focus of policy and research in the financing and delivery of health care. Previous research has documented the gaps in financing long-term care services for older people, the heavy reliance on family members as providers of care, and the strong desire of disabled older people to remain community-resident even though resources for community-based formal long-term care services are often meager and fragmented. One aspect of the long-term care "problem" that has received little attention, however, is the role of race or minority-group membership. The overall objective of the proposed research is to investigate the role of race in the structure of informal caregiving arrangements and the use of formal inhome care and nursing home care. The data are from the National Long-Term Care Surveys, a nationally representative survey of disabled people age 65 or older. In order to characterize the provision of long-term care to black disabled elders, in contrast to their white counter parts, the project will be guided by the following specific aims: 1. To describe and compare the structure of informal care arrangements of black and white disabled elders. 2. To examine the effects of psychosocial, contextual, economic factors and the structure of informal care arrangements, on black/white differences in long-term care utilization. 3. To investigate differences by race in the caregiver role and in perceptions of caregiving, and the effects on use of formal long-term care services. The goal of the proposed research is to advance our understanding of the significance of race in the provision of long-term care. It is particularly important, of course, to determine the extent to which differences by race reflect barriers to access as opposed to preferences that are more closely tied to cultural differences. By focusing on policy-related variables, such as economic resources and contextual indicators of the health services environment, as well as informal care arrangements and psychosocial factors, it is possible to begin to understand the causes of race differences in use of formal long-term care services. Equally important, such analyses will clarify the need for policy interventions to address racial inequities.