The Effects of the COVID-19 Pandemic on Long-Term Care for High-Need Older Adults with and without Alzheimer’s Disease and Related Dementias

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PROJECT SUMMARY Nearly 20 million adults (38%) aged 65 and older have limitations with one or more self-care activities (e.g., dressing, getting out of bed) and one in ten older adults are living with Alzheimer’s Disease and Related Dementias (ADRD). Together these two overlapping groups of “high-need” older adults typically rely on a variety of long-term care (LTC) sources to assist with daily activities, including family and unpaid care, paid care in the home, residential care such as assisted living and nursing home care. Inadequate care may lead to adverse consequences in daily self-care and avoidable health care utilization. The sudden onset of the COVID- 19 pandemic may have profoundly affected access to and use of LTC and contributed to further adverse consequences for high-need older adults, particularly for those living with ADRD. This project will draw upon two complementary longitudinal, nationally representative surveys of older adults–the Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS)–linked to geographic data and Medicare claims. Using statistical approaches that strengthen our ability to draw causal inferences, we will: 1) Evaluate the short-term impact (2018-2020) of the COVID-19 pandemic on the type and amount of LTC use, comparing high-need older adults with and without ADRD and identify arrangements more likely to be “stable” with lower risks of change. 2) Determine whether care trajectories were disrupted after the start of the pandemic, comparing high-need older adults with and without ADRD from 2016 through 2024/2025. 3) Assess the impact of COVID-19 on adverse consequences related to care gaps among high-need older adults with and without ADRD. We will estimate the effect of the COVID-19 pandemic on self-reports of unmet need (using NHATS) and claims-based measures of avoidable hospitalizations and emergency department visits (using HRS) for those with and without ADRD. Detailed geographic data will allow us to take into account local conditions while identifying more “vulnerable” care arrangements with higher risks of adverse consequences. The results of this project will provide a comprehensive understanding of the COVID-19 pandemic’s impact on LTC outcomes in the short and longer term. This study aligns with NIA’s priority to understand community support for dementia care, in particular the determinants of availability LTC, LTC utilization and how the effects of community level factors including infrastructure and risk environment.