As the population ages the ethnic composition is shifting. Between 2000 and 2030, there will be a substantial shift with the older African American population expanding by 168% and the older White population increasing by 90%. A growing African American elderly population will likely exacerbate existing racial disparities. Therefore, it is critical to improve our understanding of the extent, causes and implications of uneven racial distribution across the spectrum of long-term care.
Among the U.S. adult population approximately one-fifth (21%) of African-Americans provide care to an elderly family member or loved one in a home setting, but this is changing. With more Black women obtaining collegiate and/or professional degrees then pursuing professional careers there are fewer caregivers within the community. According to the 2010 census 21.4% of African American women held college degrees or higher. In general this is a great achievement and a positive step forward but in terms of elder care this creates a void of caregivers in our communities.
Cost is another factor in the racial segregation of elder care. The three most common long term care options are: nursing homes, assisted living facilities and home care. Some or all of these options may not be equally available, accessible or affordable to everybody. Annually, the national average cost for a private nursing home is $92,000, assisted living $42,000 and home care $41,000. These cost traditionally play a role in the decision to care for African American elders in the home by family members.
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Nursing homes previously catered to a predominantly white population. African Americans who resided in long term care accommodations tended to be concentrated in a few predominantly African-American facilities located in rural, non-poor, African American communities.
This is changing. The proportion of African Americans in long-term residential care facilities has increased steadily over the past four decades. In 1963, an estimated 27 white and 10 minority elderly persons per 1000 persons in the general population resided in nursing homes, yielding a minority–white ratio of 37%. In 1969 this ratio stood at 46%; by 1977 it had risen to 60%, and by 1989 it was 65%. The racial gap in use of long-term care is therefore narrowing.
A cursory look at the numbers would suggest that elderly Blacks, Hispanics and Asians are gaining greater access to nursing home care. But the growing proportion of minorities in nursing homes is coming about partly because they do not have the same access to more desirable forms of care as wealthier whites do.
In nursing homes, where African Americans are most prevalent, typically the majority of facility revenues come from Medicaid. The reliance of nursing homes on Medicaid reimbursement ensures access for poor elderly African Americans. Whites, having greater economic resources, are utilizing better more preferable alternatives, like assisted living or home care.