Significant disparities exist in senior living and care, but policymakers and lawmakers can eliminate a bias toward institutional care, such as care provided in nursing homes, by focusing on equity in home- and community-based services for older adults, according to a new paper from Justice in Aging.
“Institutional bias in long-term care often forces older adults and people with disabilities into institutions, rather than enabling them to age at home — an option many prefer,” the authors wrote. “Those who face structural inequities based on intersecting identities are more likely to be institutionalized.”
Some assisted living operators provide HCBS to residents through state Medicaid waivers.
The paper, “Fulfilling the Promise of Equity for Older Adults — Opportunities in Law & Policy,” also examines structural ageism and how law and policy can address inequities that are based on race, gender or LGBTQ+ identity.
Prioritizing equity in long-term care is one of the key areas the authors highlight to address the discrimination that intersects with age and gender identity. Many low-income older adults, the authors stated, experience barriers to care due to discrimination based on race, gender or sexual orientation.
In long-term care, the authors found, older adults of color were admitted to nursing facilities at higher rates than were their general population counterparts. The authors concluded that the finding reflects, in part, a lack of HCBS services available and accessible to people of color.
In addition, they reported, LGBTQ+ residents in senior living and care reported commonplace discrimination and mistreatment from other residents and staff members, as well as feelings of having to “go back in the closet.”
The authors recommended that policies and laws center on equity in HCBS, focusing on program design, provider availability, awareness and enrollment, assessment for and authorization of services, while eliminating biases toward institutional care.
For individuals in long-term care, they said, policies should focus on advancing equity for residents of color and LBGTQ+ residents in particular.
Other priority areas for law and policy addressed in the paper include strengthening safety net programs, improving anti-discrimination protections, refining data collection, and promoting outreach and education.
