Long-Term Care in the United States: Examining the Role of Socioeconomic Status

My research examined the association between socioeconomic status (SES) and informal versus formal care use, unmet care needs (UCN), and concordance between preferred and actual care used; exploring whether the middle class faces barriers accessing care. Each study involved a cross-sectional analysis using NHATS data. Guided by Andersen and Newman’s behavioral model of health, I explored the relationship between SES and each outcome of interest, controlling for predisposing, enabling, and need factors. Descriptive analysis characterized the sample; bivariate analysis examined the relationship between SES and each outcome of interest and associations between SES and the control variables. Logistic regression with backward elimination retained control variables with a p-value less than 0.10. Results were interpreted using adjusted odds ratios (AOR) and 95% confidence intervals (CI). The middle-SES group had decreased odds of using informal care compared to the low-SES group, but increased odds compared to the upper-SES group. The middle-SES group had increased odds of UCN compared to the low-SES group, but no significant association when compared to the upper-SES group. The middle-SES group had decreased odds of concordance between preferred care and actual care used when compared to the low-SES group, but increased odds of concordance when compared to the upper-SES group.