Differences in Living Arrangements Among Older Adults Transitioning Into the Community: Examining the Impact of Race and Choice

Abstract

The federal Money Follows the Person Rebalancing Demonstration program allows nursing home residents to use Medicaid funds for home and community-based services rather than institutional care. Race, choice in housing, and challenges faced prior to transitioning may impact living arrangements following a discharge into the community. This study examines the influence of these factors on living arrangements for 659 program participants age 65 or older. Unmarried Blacks and people with financial or legal challenges are less likely to live with a live-in caregiver or in supervised housing compared with unmarried Whites. Race did not determine living arrangements among married participants, but housing transition challenges did. Findings inform policies targeting nursing home rebalancing efforts by highlighting racial diversity in living arrangements and emphasizing the need for affordable, accessible housing options for older adults of any race seeking to live in the community rather than remain in an institutional setting.

Keywords

LTSS housing living arrangements race

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References

Administration on Aging. (2015). A profile of older Americans: 2014. Administration for Community Living, U.S. Department of Health and Human Services. Retrieved from https://aoa.acl.gov/aging_statistics/profile/2014/docs/2014-profile.pdf.

Ajrouch

K. J.

Antonucci

T. C.

Janevic

M. R.

(2001). Social networks among Blacks and Whites: The interaction between race and age. The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 56, S112-S118. doi:10.1093/geronb/56.2.S112

Brown

(2009). Choice as an aspect of quality of life for people with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities, 6, 11-18. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1741-1130.2008.00198.x/full

Brown

Irvin

Lipson

Simon

Wenzlow

(2008). Research design report for the evaluation of the Money Follows the Person (MFP) Grant Program: Final report. Princeton, NJ. Mathematica Policy Research.

Choi

N. G.

(1991). Racial differences in the determinants of living arrangements of widowed and divorced elderly women. The Gerontologist, 31, 496-504.

Choi

N. G.

(2003). Coresidence between unmarried aging parents and their adult children: Who moved in with whom and why? Research on Aging, 25, 384-404.

Colby

S. L.

Ortman

J. M.

(2015). Projections of the Size and Composition of the U.S. Population: 2014 to 2060. Washington, DC: U.S. Census Bureau.

Davis

M. A.

Moritz

D. J.

Neuhaus

J. M.

Barclay

J. D.

Gee

(1997). Living arrangements, changes in living arrangements, and survival among community dwelling older adults. American Journal of Public Health, 87, 371-377.

The Federal Interagency Forum on Aging-Related Statistics. (2016). Older Americans 2016: Key indicators of well-being. Retrieved from https://agingstats.gov/docs/LatestReport/OlderAmericans2016KeyIndicatorsofWellBeing.pdf

10.

Fields

N. L.

Anderson

K. A.

Dalbeko-Schoeny

(2011). Ready or not: Transitioning from institutional care to community care. Journal of Housing for the Elderly, 25(1), 3-17.

11.

Fingerman

K. L.

VanderDrift

L. E.

Dotterer

A. M.

Birditt

K. S.

Zarit

S. H.

(2011). Support to aging parents and grown children in Black and White families. The Gerontologist, 51, 441-452.

12.

Fry

Passel

J. S.

(2014, July). In post-recession era, young adults drive continuing rise in multi-generational living. Washington, DC: Pew Research Center’s Social and Demographic Trends Project.

13.

Hays

J. C.

George

L. K.

(2002). The life-course trajectory toward living alone: Racial differences. Research on Aging, 24, 283-307.

14.

Larsen

L. J.

(2014). Older Americans with a disability: 2008−2012 (U.S. Census Bureau, American Community Survey Reports). Washington, DC: U.S. Government Printing Office.

15.

Henning-Smith

Gonzales

Shippee

T. P.

(2016). Barriers to timely medical care for older adults by disability status and household composition. Journal of Disability Policy Studies. http://doi.org/10.1177/1044207316637547

16.

Hill

R. B.

(2008). Enhancing the resilience of African American families. Journal of Human Behavior in the Social Environment, 1(2/3), 37-41. doi:10.1300/J137v01n02

17.

Himes

C. L.

Hogan

D. P.

Eggebeen

D. J.

(1996). Living arrangements of minority elders. The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 51, S42-S48.

18.

Howell

Silberberg

Quinn

W. V.

Lucas

J. A.

(2007). Determinants of remaining in the community after discharge: Results from New Jersey’s Nursing Home Transition Program. The Gerontologist, 47(4), 535-547.

19.

Jacobsen

Kent

Lee

Mather

(2011). America’s aging population. Population Bulletin, 66(1), 1-20.

20.

Kahana

Lovegreen

Kahana

(2003). Person, environment, and person-environment fit as influences on residential satisfaction of elders. Environment and Behavior, 35, 434-453. doi:10.1177/0013916503251447

21.

Kampfe

C. M.

(2002). Older adults’ perceptions of residential relocation. Journal of Humanistic Counseling, Education, and Development, 41, 103-113.

22.

Kasper

O’Malley

(2006). Nursing home transition programs: perspectives of Medicaid care planners. Kaiser Commission on Medicaid and the Uninsured. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7483.pdf.

23.

Katz

Ford

A. B.

Moskowitz

R. W.

Jackson

B. A.

Jaffe

M. W.

(1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. The Journal of the American Medical Association, 185, 914-999.

24.

Lawton

M. P.

Brody

E. M.

(1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9(Pt. 1-3), 179-186.

25.

Lee

G. R.

Peek

C. W.

Coward

R. T.

(1998). Race differences in filial responsibility expectations among older parents. Journal of Marriage and Family, 60, 404-412.

26.

Liang

Brown

J. W.

Krause

N. M.

Ofstedal

Bennett

(2005). Health and living arrangements among older Americans: Does marriage matter? Journal of Aging and Health, 17, 305-335. doi:10.1177/0898264305276300

27.

Miller

E. A.

Weissert

W. G.

(2000). Predicting elderly people’s risk for nursing home placement, hospitalization, functional impairment, and mortality: A synthesis. Medical Care Research and Review, 57, 259-296. doi:10.1177/1077558700057301

28.

Mills

W. L.

Snow

L. A.

Wilson

N. L.

Naik

A. D.

Kunik

M. E.

(2013). Conceptualization of a toolkit to evaluate everyday competence in planning transitions from nursing homes to the community. Journal of the American Medical Directors Association, 4(8), 626.e1-626.e7.

29.

Navaie-Waliser

Feldman

P. H.

Gould

D. A.

Levine

Kuerbis

A. N.

Donelan

(2002). When the caregiver needs care: The plight of vulnerable caregivers. American Journal of Public Health, 92, 409-413.

30.

Peek

C. W.

Koropeckyj-Cox

Zsembik

B. A.

Coward

R. T.

(2004). Race comparisons of household dynamics of older adults. Research on Aging, 26(2), 179-201.

31.

Peek

K. M.

Coward

R. T.

Peek

C. W.

(2000). Race, aging, and care: Can differences in family and household structure account for race variations in informal care? Research on Aging, 22, 117-142.

32.

Pinquart

Sörensen

(2011). Spouses, adult children, and children-in-law as caregivers of older adults: A meta-analytic comparison. Psychology and Aging, 26, 1-14.

33.

Shellman

(2004). “Nobody ever asked me before”: Understanding life experiences of African American Elders. Journal of Transcultural Nursing, 15, 308-316.

34.

Spillman

B. C.

Pezzin

L. E.

(2000). Potential and active family caregivers: Changing networks and the “sandwich generation.” Milbank Quarterly, 78, 347-374.

35.

Spitze

Logan

J. R.

Robinson

(1992). Family structure and changes in living arrangements among elderly nonmarried parents. The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 47, S289-S296.

36.

Stepler

(2016, February). Smaller share of women ages 65 and older are living alone: More are living with spouse or children. Washington, DC: Pew Research Center.

37.

Swartz

T. T.

(2009). Intergenerational family relations in adulthood: Patterns, variations, and implications in the contemporary United States. Annual Review of Sociology, 35, 191-212.

38.

Vespa

B. J.

Lewis

J. M.

Kreider

R. M.

(2013). America’s families and living arrangements: 2012. Population characteristics. Washington, DC: U.S. Census Bureau.

39.

Waite

L. J.

(1995). Does marriage matter? Demography, 32, 483-507.

40.

Weissman

J. D.

Russell

(2018). Relationships between living arrangements and health status among older adults in the United States, 2009-2014: Findings from the National Health Interview Survey. Journal of Applied Gerontology, 37, 7-25.

41.

Welch

Teno

Mor

(2005). End-of-life care in Black and White: Race matters for medical care of dying patients and their families. Journal of American Geriatrics Society, 53, 1145-1153.

42.

White

L. K.

Rogers

S. J.

(1997). Strong support but uneasy relationships: Coresidence and adult children’s relationships with their parents. Journal of Marriage and Family, 59, 62-76.