THE PERSISTENCE OF RACE AND ETHNICITY IN THE USE OF LONG-TERM-CARE

We examine the use of nursing homes, formal personal care, informal Ac tivities of Daily Living (ADL) assistance, and no care to identify rac ial differences in their use. Using the 1987 National Medical Expendit ure Survey of both nursing homes and the community, multinominal logis tic regressions controlled for predisposing, enabling, and need variab les as well as other types of service use. Additional state-level vari ables make few changes in race/ethnicity parameters, indicating that r ace/ethnicity are not simply proxies for state-level variables. Older African Americans are less likely to use nursing homes than similar wh ites, with the lower institutionalization replaced by a higher use of paid home care, informal-only care, and no care. This suggests that fo rmal in-home community care is not fully compensating for the racial d ifferences in nursing home use. Persistent effects of race/ethnicity c ould be the result of culture, class, and/or discrimination that may i mpair equitable access to services.