Methods: This study used 2007 U.S. County Business Patterns data and American Community Surveys, and focused on 784 urban and rural zipcode neighborhoods in Michigan, U.S. The key outcome of interest is the presence of organizations related to home and community based care. We operationalize the organizational presence as the presence of any assisted living facility, home health care agency, and social services for elderly & disabled persons in the zip code, defined by NAICs codes. Logistic regression models are used to examine whether the neighborhood characteristics of interest were associated with three types of organizational presence across neighborhoods in the state of Michigan.
Results: Results show that the availability of home and community based services tends to benefit wealthy communities. A higher proportion of older adults and people below poverty in the community explain only part of the presence of social services. Having a nursing home in the community explains the presence of a home health agency; but this relationship was attenuated by the neighborhood’s racial distribution.
Conclusions/Implications: Neighborhood factors associated with the organizational presence differ by types of organization, reflecting the nature of organizations and the extent to which they rely on different sources of funding such as government contracts or reimbursement as a payment method among eligible clients, or private pay. A major finding—racial minority communities are predominantly served by traditional forms of institutional care rather than home based care— implies that residential inequality gets perpetuated by spatial dynamics across neighborhoods in the presence of organizations intended for older adults. Reducing under representation of organizations in vulnerable communities will foster optimal conditions for older adults aging in place.