Difference in Organizational Resources across Neighborhoods for Community-Dwelling Older Adults with Deteriorating Physical and Cognitive Health

Background/Purpose: Unlike the growing importance of local infrastructures and services that effectively accommodate the health needs of older adults, scholars have documented that organizational resources for health and social services are not equally distributed across geographic areas (Abramson 2015; Golant 2016). While these studies have illuminated important mechanisms of how geographical disparity in organizational resources for older adults’ health might generate health disparity across older adults aging in communities with different levels of organizational resources, existing studies do not examine the existence of organizations per se and discuss the ways in which different service providers operate in the community. To better understand unequal access to age-related health and social services across geographic locations, this study examines the association between neighborhood characteristics and the presence of three types of organizations intended to promote independent living of older adults in community: assisted living, home health care, and social services.

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.