Use of community-based long-term care services by older adults

This study uses a previously validated model of disease, disability, functional limitations, and perceived health to predict the use of long-term care (LTC) services in and out of the home. The focus is on (a) the direct effects of the structure of health status on the use of LTC services, (b) how the use of LTC services differs by race and sex, and (c) how the use of LTC services varies by in-home and out-of-home location. The findings indicate that different dimensions of health status affect in-home health services for White men and women, compared to Black women. Basic ADLs are significant predictors among Whites but not among Black females. In addition, sociodemographic and socioeconomic factors are more important influences on the use of out-of-home services than are health status variables. Some of these effects indicate that LTC services are being used by the special groups to which they are targeted (e.g., those living alone). The failure to find other effects (e.g., dependence on social security for income) indicates that the LTC services are not being used more by some targeted groups (e.g., the poor). These findings suggest that simply expanding the supply of LTC services could exacerbate the existing disparities in service use.