(In)Formal Support and Unmet Needs in The National Long-Term Care Survey

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We linked individual-level data from the 2004 wave of the National Long-Term Care Survey with state-level data from the National Aging Program Information Systems (NAPIS) State Program Reports to predict care mix and unmet need for assistance. Our sample consisted of 2422 community-dwelling individuals aged 65 and older (69% women, 8% nonwhite) who reported at least one limitation in an instrumental or basic activity of daily living. We used the data to predict the mix of formal and informal support received, and the probability of having at least one unmet need from individual (predisposing, enabling, and need) characteristics with statelevel home help coverage rates, intensity of home help services, and proportion of population aged 60+ residing in institutional settings. Consistent with past research, a majority (52.6%) of the disabled sample reported unmet need. At the individual level, enabling (availability of kin support) and need (number of basic and instrumental activity of daily living impairments, BADLs and IADLs) were most strongly associated with care mix and unmet need. Statelevel services were not associated with receipt of informal supports. In states providing home help services to a higher proportion of elders, women were more likely to receive formal help. In states providing more intensive services, women were less likely and individuals living alone more likely to receive formal supports. In states where a higher proportion of elders lived in nursing homes, individuals living alone were more likely to receive formal assistance, less likely overall to report unmet needs, but the oldest-old were more likely to report unmet need.