Disparities in Financial Strain Among Individuals with Needs for Long-Term Services and Supports in California

Background and Purpose: Many older adults and individuals with disabilities need long-term services and supports (LTSS) to fulfill their care needs. These groups are vulnerable to financial strain, which we define as an economic stressor that can have particularly negative effects on a person’s wellbeing. The purpose of this study is to examine disparities in the experience of financial strain among people who are in need of LTSS by age, gender, race/ethnicity, poverty level, and disability status.

Methods: This study uses data from the 2019 California Long-Term Services and Supports (LTSS) survey which was merged with data from the omnibus California Health Interview Survey (CHIS) (N=1097). The general CHIS survey is the largest state health survey in the U.S. and a critical source of data on Californians. The LTSS dataset is the most comprehensive population-level dataset to examine LTSS needs, unmet needs, and utilization in California. Disability status is measured by the combination of difficulties that people have: 1) concentrating, remembering, or making decisions; 2) performing activities of daily living (ADLs); 3) performing instrumental activities of daily living (IADLs). We use a comprehensive measure of financial strain that addresses multiple challenges that individuals encountered during the last 12 months in acquiring food, housing, health care, and/or income. We conducted univariate and binary analyses to describe disparities in the experience of financial strain among people who are in need of LTSS.

Results: Initial findings show that 50% of survey respondents report spending less on food, while 40% report cutting down on saving for retirement, receiving and borrowing money from others, and experiencing a decline in household income. More than 20% note that they could not afford their rent or mortgage payment, had debt due to medical bills, and had to spend less on prescription medications or medical care.

We also found significant disparities in these experiences by age, gender, poverty level, and disability status; however, we did not find significant disparities by race/ethnicity. Participant reports of cutting down on retirement savings varied significantly by age, gender, poverty level, and disability status. Experiences of receiving and borrowing money from others varied significantly by age, poverty level, and disability status. Participants who reported spending less on food varied by age and disability status. Those who encountered a decline in household income varied by age. Being unable to afford a rent or mortgage payment varied by poverty level. Experiences of having debt due to medical bills and spending less on prescription medications or medical care both varied by disability status.

Conclusions and implications: This study is among the first to examine disparities in various types of financial strain among people who need LTSS in California. We find that most experiences of financial strain varied by age and disability status. These findings have implications for advancing LTSS policies and programs that better address the unmet needs of individuals with LTSS needs, especially those who are disadvantaged by socioeconomic and health status.