Black-White Differences in Long-Term Services and Supports (LTSS) Deserts: Implications for Unmet Care Needs.
Chanee D Fabius, Kali S Thomas, Jennifer C Cornman and 1 others
PMID 40645233WHAT IT FOUND
Black older adults with care needs reported more adverse consequences overall.
White older adults in counties with few community care options also reported more adverse consequences, though the link was not clear after accounting for other factors. Service availability was not linked to Black outcomes.
Key findings
01Black older adults with care needs more often experienced adverse consequences due to unmet need than White older adults (35.0% vs 27.6%).
02White older adults in an LTSS desert had higher odds of adverse consequences before adjustment (OR 1.57, 95% CI 1.09 to 2.26), but after adjustment the link was not clear (aOR 1.50, 95% CI 0.95 to 2.36); no LTSS availability association was observed among Black older adults.
03Receiving community-based unpaid or paid care was associated with higher odds of adverse consequences in both Black and White older adults.
STILL TO COME
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What it does not show
The analysis is cross-sectional, so it cannot show that living in an LTSS desert causes adverse consequences due to unmet need. The LTSS measure excluded unlicensed providers, non-Medicare home care agencies, and direct care workers hired by individuals or families. The adult day service count included only providers with membership in the National Adult Day Services Association. County boundaries may be too broad to represent the care market a person can actually reach. Hispanic older adults were excluded from the analysis because of limited sample sizes. The study could not tell whether paid care came from agencies or privately hired direct care workers. For White older adults, the adjusted association with LTSS deserts was not statistically clear.
Declared interests
The supplied text lists research support from NIH extramural and non-U.S. government sources. It does not provide a separate conflicts of interest statement naming personal financial relationships.
The easy way to misread this
Do not read these associations as proof that service deserts cause unmet care needs. The study is cross-sectional, the adjusted link for White older adults was not clear, and no LTSS availability association was observed for Black older adults.