Report: Disparities Emerge In Those Seeking LTSS As They Age

People who are 55 years old, and living in a community setting in the U.S., are seeing major disparities when it comes to long-term services and supports (LTSS) needs, a new report from research and advisory firm ATI Advisory found.

ATI Advisory found that these disparities exist by examining race, gender and geography. The report was sponsored by Robert Wood Johnson Foundation, and analyzes data from the University of Michigan’s health and retirement study. ATI Advisory analyzed data from 6,232 respondents.

“Our report found that people who needed assistance, like the home care industry provides, were more racially and ethnically diverse, and more often resided in rural areas,” Nils Franco, senior analyst at ATI Advisory, told Home Health Care News. “We found resource differences, and disparities that may constrain access to home care provided by the industry, as well as an important role for Medicaid in potentially expanding access to LTSS for individuals who lack private financial resources.”

Source: ATI Advisory

Broadly, LTSS are the care services that people need when they begin to have trouble managing their activities of daily living, selfcare and diseases.

In 2020, roughly 7.7 million individuals used LTSS, and Medicaid is the most common source of coverage for these services.

Overall, Black individuals experienced LTSS needs 114% more often than white individuals, and Hispanic individuals 72% more often than white individuals, according to the report.


“The services provided by the home care industry are needed by a particularly racially and ethnically diverse population, but access to these services, using private resources, is constrained for many and especially among black or Hispanic individuals,” Franco said. “Our finding of the inequitable distribution of LTSS needs is part of a broader conversation about inequities in health care, overall, throughout the lifespan.”

Franco noted that ATI Advisory’s study underscored the importance of further research to investigate the causes behind these disparities.

In addition to disparities across race and ethnicity, the report found that individuals living in rural communities experienced LTSS needs 23% more often than individuals in urban areas.

“In rural areas, one concern is the distances providers have to travel for a connection to care among individuals who have LTSS needs,” Franco said. “To find out that LTSS needs are more common in rural counties, highlights a potential area of concern around care access for those individuals.”

The report also found that Black and Hispanic individuals, women and individuals living in rural counties had fewer private financial resources.

Source: ATI Advisory

Black and Latino individuals were also less likely to have health insurance coverage, compared to white individuals.

Source: ATI Advisory

Ultimately, the report made a number suggestions including endorsing policies that reduce disparities in financial resources, limiting barriers to Medicaid LTSS insurance coverage and designing programs aimed at delivering care for individuals without in-home support.

“We’re really trying to highlight the need for these public programs to think about some of the disparities we’re seeing,” Johanna Barraza-Cannon, director of ATI’s state program and policy practice, told HHCN. “Our continued research wants to be able to narrow and tighten some of these recommendations to be actionable. There’s a lot of room for these programs to look at these findings, and think about how they can better tailor their programs to meet these needs.”

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