WI22-07: The Geography of Long-Term Care: Implications for SSI and Understanding Disparities in Living Arrangements Among Older Adults

Abstract

Research reveals that Black older adults are overrepresented in nursing homes and underrepresented in assisted living. It could be that community-based care facilities are more likely to locate in predominantly White areas. Using a national business database and a “racial landscapes” approach to characterizing local demographics, this project explores associations between the locations of LTC facilities by type across predominantly White and non-White areas of the U.S. Across the continental U.S. we find all types of LTC are less abundant in predominantly White than in predominantly non-White areas. Yet, these differences are almost entirely mediated by socioeconomic factors. Estimates based only on metropolitan areas indicate different relationships by facility type. Assisted living without nursing care and nursing homes are more abundant in predominantly White areas than in non-White areas, but the reverse is true for adult day centers and assisted living with nursing care. We find that historical redlining grades mediate these metro estimates. We also compare estimates across states that do and do not offer supplements to federal Supplemental Security Income (SSI) payments and by Medicaid Home and Community-Based Care (HCBS) waiver participation. We find higher abundance of non-nursing home facilities in predominantly non-White communities than in White communities in states that supplement SSI, but no consistent association with the adoption of HCBS waiver programs. Although our main estimates differ across states that do and do not supplement federal SSI payments, the mix of LTC offerings in a county does not appear to be predictive of county-level SSI enrollment.