To estimate the national prevalence and sociodemographic correlates of gray market utilization, consisting of paid providers who are unrelated to the recipient, not working for a regulated agency, and potentially unscreened and untrained, for aging and dementia-related long-term care.
Methods
We surveyed a nationally representative sample of 1,037 American Life Panel respondents aged 18 years and older.
Results
Nearly a third of Americans who arranged paid care sought gray market care for persons with dementia, and most (65%) combined it with unpaid care. Respondents who arranged gray market care had 66% lower odds of currently working, and those living in rural areas had an almost 5-times higher odds of arranging dementia gray market care.
Discussion
Gray market care represents a substantial proportion of paid, long-term care for older adults and may fill gaps in access to care.
FavreaultM. M.GleckmanH.JohnsonR. W. (2015). Financing long-term services and supports: Options reflect trade-offs for older Americans and federal spending. Health Affairs, 34(12), 2181–2191.
2.
FeinbergL. (2012). Moving toward person-and family-centered care. Insight on the Issues, AARP Public Policy Institute on 60.
3.
FeldmanP. H.RyvickerM.EvansL. M.BarrónY. (2019). The homecare aide workforce initiative: Implementation and outcomes. Journal of Applied Gerontology, 38(2), 253–276.
KellyC.Craft MorganJ.KempC. L.DeichertJ. (2020). A profile of the assisted living direct care workforce in the United States. Journal of Applied Gerontology, 39(1), 16–12.
NewquistD. D.DeLiemaM.WilberK. H. (2015). Beware of data gaps in home care research: The streetlight effect and its implications for policy making on long-term services and supports. Medical Care Research and Review, 72(5), 622–640.
10.
NgyuenV. (2017). Long-term support and services—AARP facts sheet. AARP Public Policy Institute.
11.
NisbetE.MorganJ. C. (2019). Where policy meets practice: Employer perspectives on scheduling and hours for home care aides. Journal of Applied Gerontology, 38(11), 1615–1634.
RedfootD.FeinbergL.HouserA. (2013). The aging of the baby boom and the growing care gap: A look at future declines in the availability of family caregivers. Insight on the Issues, 85, 1–12.
14.
ShihR. A.ConcannonT. W.LiuJ. L.FriedmanE. M. (2014). Improving dementia long-term care: A policy blueprint. Rand Health Quarterly, 4(2), Article 2.
15.
SiconolfiD.ShihR. A.FriedmanE. M.KotziasV. I.AhluwaliaS. C.PhillipsJ. L.SalibaD. (2019). Rural-urban disparities in access to home- and community-based services and supports: Stakeholder perspectives from 14 states. Journal of the American Medical Directors Association, 20(4), 503–508.
16.
SquiresA.PengT. R.Barrón-VayaY.FeldmanP. (2017). An Exploratory Analysis of Patient-Provider Language-Concordant Home Health Care Visit Patterns. Home Health Care Management Practice, 29(3), 161-167.
