Intended use of informal long-term care: The role of race and ethnicity

Objective. To examine the role of race/ethnicity in the use of informal long-term care among African American and white elders, using an expanded Andersen model of health services use (Bradley et al., Health Services Research, vol. 37, pp. 1221-1242, 2002). Design. Four hundred respondents (n = 200 African American; n = 200 white) aged 65 and older, who had been hospitalized within the last year. Data were collected using a cross-sectional survey analyzed with ordered logistic regression. Independent variables included individuals' predisposing factors, enabling factors, need, and psychosocial factors. Intended use of informal long-term care was defined based on responses to a hypothetical scenario of future use of unpaid services by family members, relatives, friends, or neighbors for help with daily needs. Results. African American respondents were more likely than white respondents to intend to use informal long-term care. This effect persisted (p < 0.05) after controlling for predisposing, enabling, and need factors. However, race/ethnicity-related differences in intended use were attenuated substantially (14-18%) after controlling for psychosocial differences. Further, in the fully adjusted models, race/ethnicity was no longer significantly associated with intended long-term care use. Conclusions. Psychosocial factors, particularly social norms concerning family caregiving, mediated the relationship between race/ethnicity and intended use of informal long-term care. A fuller appreciation of the multiple influences on healthcare decision making of older adults has the potential to inform policy efforts to appropriately meet the respective long-term care needs of an ethnically diverse frail older population.