Relationship Status and Long-Term Care Facility Use in Later Life

Abstract

Objectives: Most older adults prefer to "age in place" and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk.

Method: We fit hazard models to a sample of adults aged 65 and older from eight waves (1998-2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays.

Results: Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use.

Discussion: By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options.

Keywords: Family sociology; Gender; Health services use; Long-term care; Longitudinal methods; Minority aging (race and Hispanic ethnicity).

Figure 1.

Hazard ratio and confidence intervals for divorced/separated, widowed, and never married stratified by race (Non-Hispanic Black and Non-Hispanic White); Health and Retirement Study, 1998–2012 (n = 8,353; Reference is continuously married).