Community and individual race/ethnicity associated with health-related home care use among older adults in the United States

OBJECTIVE: Understanding factors associated with home health care use is an important public health concern as policymakers, older adults, and families are seeking ways to promote “aging in place” by ensuring accessibility to health-related services at home. This study investigates whether the interaction between individual race/ethnicity and community racial/ethnic composition is associated with home health care use among older adults in the United States. METHODS: A nationally representative sample of community-dwelling older adults, aged 65+, from the 2000-2006 Medical Expenditure Panel Survey (N=23,792) was linked to block group-level racial/ethnic information from the 2000 Decennial Census. We estimated the likelihood of informal and formal home health care use for four racial/ethnic groups (non-Hispanic (NH) Whites, NH-Blacks, NH-Asians, and Hispanics) living in communities with different racial/ethnic compositions. RESULTS: NH-Asian and Hispanic older adults living in block groups with ≥25% of residents being NH-Asian or Hispanic, respectively, were more likely to use informal home health care than their counterparts living in other block groups. Results for NH-Whites and NH-Blacks were not statistically significant. Furthermore, no such effect was apparent for formal home health care. CONCLUSIONS: NH-Asian and Hispanic older adults are more likely to use informal home care if they live in communities with a higher proportion of residents who share their race/ethnicity. A better understanding of how informal care is provided in different communities may inform policy makers concerned with promoting informal home care, supporting informal caregivers, and providing formal home care as a substitute or supplement to informal home care.