Despite greater rates of disability among minority older adults, home- and community-based services are underused by this group and their caregivers. A recent study of 1,749 Hispanic, African American and white older adults and their caregivers looks at the variations between individuals in these racial/ethnic groups who received Older American Act Title III caregiver services in 2009. Additionally, the study examined the volume of services used by caregivers of these individuals, their unmet hours of respite care, and the relationship between service use and the ability to live independently.
In terms of the differences in caregiver characteristics, Hispanic and African American caregivers were more likely to be younger than 64 than white caregivers. Sixty-five percent of Hispanic caregivers and 63 percent of African American caregivers were under 64, compared to 47 percent of white caregivers. In part, this reflects differences in the relationship of the caregiver to the care recipient. For whites, 45 percent of the caregivers were spouses or parents, compared to 24 percent for Hispanics and 20 percent for African Americans. Child or son-or daughter-in-law caregivers were much more common among African American (69 percent) and Hispanic (62 percent) caregivers, compared to whites (46 percent).
Significant income disparities between these caregivers were also observed. Only 56 percent of African American caregivers reported household income above $20,000, compared to 65 percent of Hispanics and 77 percent of white caregivers. African American caregivers were also more likely to be female than Hispanics and whites, although the proportion of female caregivers was high for all groups: 80 percent for African Americans, and 72 percent for both Hispanics and whites.
The functional status of the care recipients differed significantly across the three racial/ethnic groups examined here, with recipients of care from a minority caregiver being more disabled than white care recipients. Hispanic caregivers were more likely to report recipients needing assistance with three or more instrumental activities of daily life (activities that allow an individual to live independently, such as housework, shopping, and managing money). Ninety-nine percent of Hispanic caregivers reported needing to provide assistance for this many activities, compared to 94 percent of African Americans and 90 percent of whites. The conditions of hypertension, high cholesterol, diabetes, and kidney disease were also reported to be more prevalent for care recipients of African Americans (91.2 percent) and Hispanics (84 percent) than whites (78 percent). Sixty-seven percent of African American caregivers reported that the care recipient would no longer be able to remain in the same residence if caregiver assistance became unavailable, compared to 57 percent of whites and 45 percent of Hispanics.
There were also significant differences between these groups in their usage of available support from an Area Agency on Aging (AAA) funded by the Older Americans Act or community-based agencies. Hispanic caregivers were more likely to access support services from community-based agencies, and least likely to access support services from AAAs. On the other hand, African Americans were more likely than the other ethnic groups to rely on AAAs to facilitate access to support. Hispanic caregivers also reported that 43 percent of their care recipients received fewer hours of respite care than what the recipient was estimated to need, compared to 32 percent of African Americans and 28 percent of whites. The study also determined that for minorities, Older Americans Act services are disproportionately reaching more highly educated minority care recipients.
Taken together, the above suggests that minority older adults and their caregivers may require a larger menu of services and better coordination of care to achieve the same level of independence seen by whites. This study also suggests that there is a need for additional outreach and communication efforts in order to reach broader segments of the older population.
Herrera AP, George R, Angel JL, et al. Variation in Older Americans Act caregiver service use, unmet hours of care, and independence among Hispanics, African Americans, and whites. Home Health Care Services Quarterly (2013); 32(1): 35–56.