Available long-term care data cannot provide a definitive answer to the question underlying our proposed research - what is the relative contribution of ethnicity and social class to explaining reported differences among various ethnic groups in need for and use of long term care services? With a rapidly increasing older population with substantial ethnic diversity, the concern of public policymakers is with increased demand for publicly funded long-term care services. Projections for long-term care services can be based either on need or on demand. Since national data consistently show that need exceeds demand or use, projections based on need are likely to be inflated. The development of accurate long-term care projections based on demand requires a detailed understanding of factors influencing utilization. In the case of minority elders, the influence of social class/socioeconomics status and ethnicity on use of long-term care services must be disentangled. In almost all work to date on minority elderly populations, ethnic comparisons are inextricably confounded with social class. Thus, we propose a comparative observational study of multicultural population with two important study design features: 1) Location of the study in a community that provides equal access to long-term care (i.e., a single entry point to publicly-funded community longterm care services available at no cost to low-income elders) to permit the disentanglement of social class and ethnicity; and 2) inclusion of three ethnic groups - African-American, Puerto Rican, and White elders - to move beyond the within-group or two-group comparisons of almost all work to date.
The Specific Aims of the study are to: 1) Identify and describe current needs for community-based long-term care assistance and patterns of informal care and use of formal services within and between African-American, Puerto Rican, and White elders; and 2) Investigate the relative contribution of ethnicity and socioeconomic status (social class) to explaining variability in both need for care and receipt of care - informal care and/or use of formal services. Detailed data regarding the elders' needs for long-term care assistance and their receipt of informal care and use of formal services (both types and amounts) will be gathered in telephone interviews with a representative sample of 3000 persons age 60+ (1000 in each ethnic group) residing in Springfield, MA. -Data will also be gathered from the primary informal caregiver of those elders determined to be functionally disabled. In addition, we propose 1) a substudy to investigate ethnic differences in self-report vs. observed functional performance; and 2) interviews with community leaders and agency staff regarding their perceptions of the needs for care and factors influencing use of services by Black and Puerto Rican elders.
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