Structural barriers to the use of formal in-home services by elderly Latinos

We examined data on elderly Latinos to identify structural barriers that influence the use of a visiting nurse, home health aide, and/or homemaker, and to investigate possible cultural influence on use. Data are from the 1988 Commonwealth Fund Commission's national survey of 2,299 Latinos age 65 and over. Logistic equations are estimated for all elderly Latinos, those with a hospitalization in the past year, and those without a hospitalization. Need factors consistently increase the odds of using services. The significance of Medicaid and poverty income demonstrates income barriers to community-based care. Living arrangements improve our models only for those with a hospitalization in the past year. Acculturation has no independent effect, although some other findings can be interpreted as cultural preferences. We conclude that a universal, public long-term care program would substantially reduce barriers faced by elderly Latinos, but that nonfinancial barriers are likely to continue.