Racial Differences in Formal Long-Term Care: Does the Timing of Parenthood Play a Role?

Abstract

This article examines the association between race and the timing of formal long-term care (LTC) service use, both institutional and community based. It seeks to understand whether early parenthood predicts the timing of LTC use later in life and whether it in turn mediates the association between race and LTC use. In particular, it explores whether the lower rate of formal LTC use among African Americans is due in some part to the earlier inception of parenthood. Linking measures from the 1989 National Long-Term Care Survey with Medicare claims (1989-1993), we model age at first use of institutional (skilled nursing facility) care and home health as competing risks using a Cox proportional hazards model. Early parenthood accelerates first use of home health for Whites but delays first use for Blacks. The likelihood of any LTC use by race group converges as timing of parenthood increases. Differential effects of teen childbearing across race groups indicate differential vulnerability to LTC needs among early parents.