Effects of Long-term Services and Supports on Survival of Poor, Highly Vulnerable Older Adults.

ABSTRACT

BACKGROUND AND OBJECTIVES: We explore how an understudied population of older individuals addresses their ongoing care needs when ineligible for Medicaid waiver services. RESEARCH DESIGN AND METHODS: Using regression techniques, we identified factors associated with service use and health outcomes among 1,008 older adults (60+) who applied for Medicaid waiver assistance. Exploratory follow-up interviews with eight waiver-ineligible rural-dwelling individuals identified strategies used for managing their care needs. RESULTS: Mortality was high among study participants. Specifically, being waiver-ineligible increased the risk of mortality. Waiver-ineligible individuals were more likely to access alternative services and supports. Rural-dwelling older adults were less likely to be waiver-eligible, but twice as likely to access alternative services and supports, compared to nonrural older adults. Participants interviewed had ongoing unmet needs, relied on family and community services, and used internal and external strategies to manage care needs. DISCUSSION AND IMPLICATIONS Having unmet needs increased the risk of mortality, whereas receiving full waiver services extended the lives of recipients. More generous services extend the lives of older, highly vulnerable, community-residing older people. Less generous services also extended life, but not to the same extent. Individuals without formal assistance relied on various strategies to confront ongoing daily challenges. Assisting a broader range of older adults with unmet needs is essential in addressing care needs and maintaining functional capacity to remain at home.