Unaddressed functional difficulty and care support among White, Black, and Hispanic older adults in the last decade

Abstract

Abstract Unaddressed functional difficulties contribute to disparities in healthy aging. While the Affordable Care Act (ACA) is believed to have reshaped long-term care, little is known on how it has collectively altered the prevalence of older adults with functional difficulties and their use of family and formal care. This study uses nationally representative data from the Health and Retirement Study (2008–2018) to describe racial-ethnic differences in the prevalence of community-dwelling older adults who had difficulty with, but lacked assistance for, self-care, mobility, and household activities before and after the ACA. Individuals with functional difficulties accounted for about one-third of Black and Hispanic individuals, compared to one-fifth of White people. The prevalence of Black and Hispanic people with functional difficulties lacking corresponding care support was consistently 1.5 times higher than that of White people. Racial-ethnic differences disappeared only for low-income households where unaddressed difficulties were uniformly high. While formal care quantity was similar, Black and Hispanic people with functional difficulties received nearly 50% more family care than White people. These gaps between White, Black, and Hispanic older adults were persistent over time. These findings suggest that racial-ethnic gaps in aging needs and supports remain despite major health care reforms in the past decade.