Structural Barriers to the Use of Formal In-Home Services by Elderly Latinos

Abstract

We examined data on elderly Latinos to identify structural barriers that influence the use of a visiting nurse, home health aide, and/or homemaker, and to investigate possible cultural influence on use. Data are from the 1988 Commonwealth Fund Commission's national survey of 2,299 Latinos age 65 and over. Logistic equations are estimated for all elderly Latinos, those with a hospitalization in the past year, and those without a hospitalization. Need factors consistently increase the odds of using services. The significance of Medicaid and poverty income demonstrates income barriers to community-based care. Living arrangements improve our models only for those with a hospitalization in the past year. Acculturation has no independent effect, although some other findings can be interpreted as cultural preferences. We conclude that a universal, public long-term care program would substantially reduce barriers faced by elderly Latinos, but that nonfinancial barriers are likely to continue.

Medicaid Community-Based Programs: A Longitudinal Analysis of State Variation in Expenditures and Utilization

“…Among the predisposing sociodemographic characteristics in Andersen's (1995) model, LTC and policy studies demonstrate the significance of age and gender. Because the older age of a state population is associated with greater use of LTC (Mauser and Miller 1994;Wallace, Campbell, and Lew-Ting 1994;Logan and Spitze 1994), the aging of a state population, particularly growth in the oldest old, was expected to have a positive influence on both HCBS utilization and expenditures (Mendelson and Schwartz 1993). Similarly, having higher percentages of women in the labor force (who would be unavailable to care for elderly and disabled family members) also was expected to increase the demand for, and spending on, HCBS (Kemper 1992;Houde 1998).…”

Factors Affecting Utilization of Health Services and Home- and Community-Based Care Programs by Older Taiwanese in the United States

“…However, in applying the Andersen model to explain utilization behavior among minority groups, some researchers argue that the model is not sensitive to the diverse cultural and structural barriers in health care (Moon, Lubben, and Villa 1998;Wallace et al 1992Wallace et al , 1994Wolinsky and Johnson 1991). Andersen (1995) himself agreed that only by careful integration of cultural and structural variables could the Andersen model best explain service utilization for ethnic minorities in their social contexts.…”

The relationship between ethnoracial group and functional level in older persons

“…For example, there is evidence of regional differences in function between Mexican Americans in Texas and California. 52 In a national sample, older Latinos reported more restricted activity days than non-Latino whites (46.5 vs 38.7), but fewer than blacks (56.9), 64 with older Puerto Ricans reporting the highest number of restricted activity days (61.4). The predominant Latino subgroup in our sample was Puerto Ricans, which may contribute to the higher levels of functional impairment for Latinos in our study.…”