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Racial and Ethnic Differences Among Older Adults in Long-Term Care Service Use

Demographics

The numbers and proportions of older people of diverse racial and ethnic origins in the United States are increasing. In 1990, ethnic minorities represented 13% of the population age 65 and older—a percentage that rose to 16% in 2000 and is projected to increase to 23% by 2020 and to 36% by 2050. This increase is due both to higher birth rates and to immigration among racial and ethnic minority populations.

The age distribution of the population age 55 and older varied considerably among racial and ethnic groups in 2002 (see Table 1). The majority of American Indians and Alaska Natives, Asians, and Hispanics over age 55 were in the 55-64 age group and less than 20% were age 75 or older. In contrast, among Blacks and Whites age 55 and over, more than 20% of Blacks and 28% of Whites were age 75 or older.

TABLE 1
Percentage of People by Age Group, Race and Ethnicity

  55-64 65-74 75-84 85+
American Indian & Alaskan Native 51.7% 30.0% 14.6% 3.6%
Asian & Pacific Islander 51.1 30.0 16.1 2.9
Black 46.7 33.0 16.1 4.3
Hispanic 50.6 30.6 14.7 4.1
White 42.1 30.1 21.6 6.2
Source: U.S. Census Bureau, The Older Population in the United States: March 2002. Issued April 2003

Disability

Like demographic trends, changes in disability rates among older racial and ethnic minorities are likely to affect the long-term care system. Older Blacks continue to have higher disability rates than older Whites and other ethnic groups, although disability rates, in general, are on the decline for all groups. According to the 1999 National Long-Term Care Survey (NLTCS) of persons age 65 and older, the reported rate of disability declined for Blacks from 30% to 25% (a relative decline of 17%). For Whites and others, the decline was from 21% to 19% (a relative decline of 10%).

The NLTCS sampling design did not include Hispanics, Asians, or Native Americans. However, data from other sources indicate that disability rates for Native Americans and Alaska Natives are much higher than for other groups.

The Use of Formal Services

In the past, the use of formal long-term care services by Blacks, Hispanics, and Asians, age 65 and older, has been shown to be substantially lower than that of non-Hispanic Whites. Cultural preferences, language differences, and lower income may explain some of the limited use of services.

However, the use of formal services has changed gradually over time for Blacks as anti-discrimination laws and public funding have provided greater access to nursing homes and home health services. Data from the 1999 National Nursing Home Survey (NNHS) indicate that, while nursing home utilization rates have declined for Whites, utilization rates have increased for Blacks and now surpass those of Whites.

Although data on the use of formal services by Asians, Hispanics, and Native Americans are limited, a study by Himes et al. provides evidence that nursing home utilization rates are much lower among these groups than among Whites or Blacks. Using 1990 U.S. Census data on persons age 60 and older, their study shows that nursing home use was 3.3% for Whites, 3.1% for Blacks, 2.3% for Native Americans, 1.6% for Hispanics, and 1.2% for Asians. Lower rates for Asians, Hispanics, and Native Americans may reflect a cultural preference for family caregiving.

The 1999 NNHS also documented some important racial differences in the ages of the nursing home population. As shown in Table 2, Black and other non-White nursing home residents were significantly younger than White residents.

TABLE 2
Percentage of Nursing Home Population by Age Group and Race, 1999

  <65 65-74 75-84 85+ Total
White 8.3% 11.3% 31.6% 48% 100%
Black 18.5 16.9 32.8 31.8 100
Other Non-White 16.6 15.0 33.8 34.6 100
Source: 1999 National Nursing Home Survey Note: Respondents who reported white race and another race are included in the "other non-whites" category. The percentages in the "other non-whites" category are less reliable because of the small number of cases upon which the analysis is based.

 

In addition, the 2000 National Home and Hospice Care Survey looked at another type of formal service, i.e., home health care. According to the survey, home health care use was higher among Blacks age 65 and older (38.2 per thousand population) than among Whites of the same age group (24.6 per thousand population).

The Role of Family Caregiving

The majority of older people needing care, of any racial and ethnic background, remain in the community and are cared for by family and friends. However, the extent to which family and friends provide assistance varies across racial and ethnic groups, reflecting both cultural and socio-economic differences. Cultural explanations for the differences have emphasized consumers’ attitudes, backgrounds, beliefs, and behaviors. Among these cultural differences are household and living arrangements that affect informal care and formal service use.

A 2001 survey on multicultural boomers by AARP found that Asians, Blacks, and Hispanics are more likely to have three generations under one roof or extended family living in the home than Whites. Furthermore, Asians (42%) were more likely to care for an older relative than Hispanics (34%), Blacks (28%), or Whites (19%). A recent study by the National Alliance for Caregiving and AARP showed that, overall, Asian, Black, and Hispanic caregivers provide similar types of care and experience similar stresses and, amng these groups, Hispanic caregivers are more likely to say they live with the person they care for.

Conclusion

The growth in the number of older people of different racial and ethnic backgrounds, changes in disability rates among the different racial and ethnic groups, and patterns of both formal and informal long-term supportive service use among these groups need to be considered in state and national planning for future long-term services.

Footnotes

  1. U.S. Census Bureau, The Older Population in the United States: March 2002. Issued April 2003
  2. National Institute on Aging and Duke University Center for Demographic Studies, 1999 National Long-Term Care Survey. February 2003.
  3. Wallace, S.P., L. Levy-Storms, R.S. Kingston, and R.A. Anderson. 1998. "The Persistence of Race and Ethnicity in the Use of Long-Term Care." Journal of Gerontology, Vol. 53B, No. 2, No. 6, pp. 28-42; Damon-Rodriguez, J., S.P. Wallace, and R. Kingston. 1994. "Service Utilization and Minority Elderly: Appropriateness, Accessibility and Acceptability." Gerontology and Geriatrics Education, 15, pp. 45-65; Dilworth-Anderson, P., I.C. Williams, and B. E. Gibson. 2002. "Issues of Race, Ethnicity, and Culture in Caregiving Research: A 20-Year Review (1980-2000)." The Gerontologist, Vol. 42, No. 2, pp. 237-272. 
  4. Centers for Disease Control and Prevention/National Center for Health Statistics, 1999 National Nursing Home Survey. June 2002.
  5. Himes, Christine L. et al. Living Arrangements of Minority Elders. 1996. Journal of Gerontology, 51B, No. 1, pp. S42-S48.
  6. National Center for Health Statistics, 2000 National Home and Hospice Survey. August 2003. 
  7. In the Middle: A Report on Multicultural Boomers Coping with Family and Aging Issues. A National Study Conducted for AARP, July 2001. 
  8. National Alliance for Caregiving and AARP. Caregiving in the U.S., 2004.

Written by Sheel M. Pandya, AARP Public Policy Institute
June 2005
©2005 AARP
All rights are reserved and content may be reproduced, downloaded, disseminated, or transferred, for single use, or by nonprofit organizations for educational purposes, if correct attribution is made to AARP.
Public Policy Institute, AARP, 601 E Street, NW, Washington, DC 20049

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