Paying for Senior Care-Need to Increase Options for Low-Income Seniors

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Because older adults prefer to “age in place,” we have witnessed an increase in the utilization of home- and community-based long-term care services and supports and a shift away from nursing homes. However, findings from a study published in Health Affairs indicate that enrollment in skilled nursing facilities has declined for older Whites, but has increased for seniors of color. It appears that many White seniors may have more choices of long-term care in their communities and the means to pay for alternatives largely used by those with private pay insurance.

Burdened families of color can not always handle the caregiving and as a result, many low-income seniors end up as residents in low-quality skilled nursing facilities which are significantly more expensive. We need to increase the housing options for low-income seniors.

Many seniors of color, however, are more likely to reside in socioeconomically disadvantaged communities with limited options for long-term care besides nursing homes. Unfortunately, families that have traditionally provided much of the long-term care for seniors are unable to meet the demands of their expensive, complex and multiple care needs.

As the number of older racial and ethnic minorities increases, the demand for and use of nursing homes will also increase. So, while we continue to advocate for policies to increase access to more preferred long-term care options for low-income seniors, we can also engage in other strategies that have the potential to increase access to available and varied long-term care.

Lack of Knowledge

Studies show that lack of knowledge and awareness are directly linked to participation in programs for seniors. Studies of the Medicare Saving Programs (MSPs) found that lack of knowledge about the programs was the leading barrier to enrollment. A national survey of Medicare beneficiaries found that 79% of eligible beneficiaries who were not participating in the MSPs had never heard of the programs.

Another national survey of seniors reported that lack of awareness about the Medicare Part D Low-Income Subsidy benefits was a barrier to participation, particularly among low-income seniors of color. Research also shows that some Medicaid eligibility workers and counselors are not aware of available programs.

A study conducted by Advocates for African American Elders of 550 African American seniors in Los Angeles County found that 27.4% were not aware of senior programs in their neighborhood, such as Meals on Wheels, In-Home Supportive Services, adult day care and wellness centers. Seniors age 50-64 (67.5%) and those with less than a high school education (80%) were least likely to be aware of these programs. Findings also indicated that 42.5% of seniors were not aware of senior services in their neighborhood, including senior public assistance, senior housing, assisted living, or senior legal and financial assistance. Findings from this study also highlight the need to increase the level of long-term care planning by individuals in their pre-retirement years.

A study by the Associated Press-NORC Center for Public Affairs Research revealed that 65% of Americans 40 years or older report doing only a little planning for their long-term care needs or none at all.

Outreach and education initiatives by organizations that serve vulnerable seniors can increase the level of knowledge and awareness of available services and programs for which seniors are eligible. More knowledge and awareness can lead to greater participation in senior programs that can potentially delay nursing home placement for low-income seniors or avoid it all together.

Here are a few things that organizations serving low-income seniors can do to increase outreach and education:

  • Disseminate information about long-term care options to senior centers, senior housing communities, neighborhood clinics, local churches, community centers, beauty salons, barber shops, grocery stores, drug stores, and other places that low-income seniors frequent.
  • Use culturally appropriate images and messaging to engage seniors.
  • Take advantage of ethnic and cultural media, including newspapers and radio to disseminate information.
  • Partner with churches, physicians, neighborhood clinics, and pharmacies to help identify and educate seniors who might be “hard-to-reach” because they are poor, isolated, or in poor health.
  • Advocate on behalf of low-income seniors to encourage policy makers and service providers to increase the quality and quantity of services and programs for low-income seniors.

Low-income seniors can benefit significantly from participation in long-term care services and supports in their communities. Small investments in outreach and education can increase participation and access to more preferred long-term care options for seniors who might otherwise have very few choices.

Karen D. Lincoln is an associate professor in the USC School of Social Work as well as director of the USC Hartford Center of Excellence in Geriatric Social Work, and associate director at the USC Edward R. Roybal Institute on Aging at the University of Southern California. She is also founder and chair of Advocates for African American Elders.

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