Reducing racial disparities could ease pressure on long-term care: study

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Pressures on the long-term care delivery system caused by the aging of the population could be offset in part by determining how to reduce disability-related racial disparities that cause blacks to depend more on the system than whites. That's according to new research published Monday as part of the August issue of Health Affairs.

Vicki Freedman, Ph.D., of the University of Michigan, and Brenda Spillman, Ph.D., a senior fellow in the Health Policy Center at the Urban Institute, examined data from the 1982 and 2004 National Long Term Care Surveys and the 2011 National Health and Aging Trends Study, research that tracks long-term disability trends in the United States.

Although they found that life expectancy has increased for both groups, they also found that whites aged 65 or more years can expect to live disability-free for three-fourths of the remaining years of their lives, whereas blacks can expect to live disability-free for two-thirds of the remaining years of their lives. “Our analysis also suggests that the black-white gaps persisted during the study period in large part because of the lack of progress for older black women in gaining years of active life,” the authors wrote.

Over the time period studied, Freedman and Spillman observed a trend of the provision of care moving from nursing homes to community settings, including assisted living communities, which they called “encouraging.” They noted, however, that this trend was limited to whites.

Rates of nursing home use by blacks were flat over the study period. The abilities to do laundry, do light housework and shop for groceries without help are important to remaining in the community, the authors noted, and as they aged, blacks were more likely to report increased difficulty with these tasks.

More research is needed to determine whether financial support for assistive devices and home modifications, value-based payments, integrated service delivery and other approaches would reduce the rate of disabilities in blacks and, therefore, their dependence on the healthcare system, the authors wrote.

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