Black-White Differences in Long-Term Services and Supports (LTSS) Deserts: Implications for Unmet Care Needs

Chanee Fabius; Kali S Thomas; Jennifer C Cornman; Vicki A Freedman

doi:10.1016/j.jamda.2025.105758

Black-White Differences in Long-Term Services and Supports (LTSS) Deserts: Implications for Unmet Care Needs

J Am Med Dir Assoc. 2025 Jul 8:105758. doi: 10.1016/j.jamda.2025.105758. Online ahead of print.

Authors

Chanee Fabius¹, Kali S Thomas², Jennifer C Cornman³, Vicki A Freedman⁴

Affiliations

¹ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: cfabius1@jhu.edu.
² School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
³ Jennifer C. Cornman Consulting, Columbus, OH, USA.
⁴ Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.

PMID: 40645233
DOI: 10.1016/j.jamda.2025.105758

Abstract

Objectives: Little is known about the impacts of living in a long-term services and supports (LTSS) "desert," where there are few community-based care options. We sought to understand whether racial disparities exist in LTSS availability and variety and associations with unmet care needs for non-Hispanic White and Black older adults.

Design: Cross-sectional study of national survey data linked to contextual LTSS market measures.

Setting and participants: Non-Hispanic White (n = 1751) and Black (n = 603) adults aged 70 and older with activity limitations from the 2019 National Health and Aging Trends Study (NHATS).

Methods: The outcome of interest is any adverse consequence as the result of unmet care needs for household, self-care, or mobility activities. We estimate multivariable logistic regression models adjusting for a novel measure reflecting LTSS availability and variety (fertile, typical, desert), consisting of the number of home health agencies, residential care/assisted living beds, and adult day care providers in a county per 100,000 older adults.

Results: Relative to White older adults, Black older adults more often experienced adverse consequences due to unmet need (35.0% vs 27.6%, P < .03). Although not statistically significant, older Black adults were more likely to live in an LTSS desert (P < .058). In fully adjusted within-group multivariable logistic regression models, living in an LTSS desert was associated with greater odds of experiencing adverse consequences due to unmet need among White, but not Black, older adults (adjusted odds ratio, 1.50; 95% CI, 0.95-2.36). For both White and Black older adults, single older adults and those receiving unpaid or paid community-based care were more likely to experience adverse consequences due to unmet need.

Conclusions and implications: Findings underscore differences in how LTSS availability and variety relate to unmet care needs for Black and White older adults. Future research should examine these associations in other racial and ethnic minoritized groups.

Keywords: Long-term services and supports; disparities; place-based.