WI22-07: The Geography of Long-Term Care: Implications for SSI and Understanding Disparities in Living Arrangements Among Older Adults

Roughly 70% of older adults will need long-term care over their lifetimes. Surveys indicate most prefer community settings, like adult day care or assisted living, over nursing homes. However, research reveals that Black older adults are overrepresented in nursing homes and underrepresented in assisted living. It could be that community-based care options are less likely to be located in communities of color, and this lack of local options may contribute to racial disparities. Using a national business database spanning 1998-2019, this project explores the locations of nursing homes, assisted living facilities, and adult day centers in the context of the local demographic and socioeconomic characteristics of communities. Our work also examines potential correlations between care locations and local policies and practices, including state and local Medicaid long-term care policies, state supplements to federal Supplemental Security Income (SSI), and historical redlining practices that have legacy impacts on home values in local communities. Finally, prior research indicates Medicaid programs that have expanded home and community-based care may lead more older adults to apply for Supplemental Security Income to help with living expenses. This may also mean the local availability of and trends in community-based care options could help to predict SSI applications. This research aims to inform policies that can provide more equitable financial, housing, and long-term care options for older adults.