Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum

Abstract

Abstract Objective To examine how different care arrangements across the long-term care continuum are associated with experiencing unmet care need consequences (UCNC), such as skipping meals, going without clean clothes, or taking the wrong medication. Methods We include older adults receiving assistance with at least one self-care, mobility, or household activity (for health/functioning reasons) in the 2015 National Health & Aging Trends Study (N = 2,388). We examine the likelihood of experiencing a UCNC across the long-term care continuum: those receiving unpaid community care only, paid community care, and residential care. Cross-sectional logistic and longitudinal multinomial logistic regression models examine if type of care arrangement in 2015 is associated with UCNC in 2015 and change in UCNC by 2017. Results In adjusted cross-sectional models, paid community care recipients had roughly two times greater odds of experiencing a UCNC in 2015 compared to those living in residential care or receiving only unpaid care. In adjusted longitudinal models, the risk of experiencing persistent UCNC (compared to having needs met in both years) was 4.81 times higher for those receiving paid community care compared to those in residential care and 2.17 times that of those receiving unpaid care only. Discussion Older adults receiving paid care face significant and consequential gaps in care, particularly in comparison to those in other care arrangements. More attention is needed to determine how paid care arrangements can be improved and/or expanded to meet the needs of the growing number of older adults receiving paid care in the community.