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Reimagining and Transforming Long-Term Care

SPA Professor Examines Racial Inequities in Elder Care

COVID-19 has been particularly devastating for older people of color, who experience higher rates of infection, hospitalization, and death than their white counterparts. A new paper suggests that this disparity is not random, but the direct result of years of systemic inequality, which can, and should, be addressed.

Jean Accius, SPA/PhD ’08, an SPA adjunct professorial lecturer, coauthored Reimagining and Transforming Long-Term Care, which was published in the spring 2022 issue of Generations Journal.  A senior vice president of AARP Global Thought Leadership, Accius partnered with Edem Hado, a policy research senior analyst at the AARP Public Policy Institute, on the project.

“We wanted to really elevate some of the challenges, particularly with the system — or the lack of a system — in terms of delivering the type of care,” Accius, said citing long-term care’s lack of affordability, poor coordination, and low public awareness. “COVID amplified and exacerbated a lot of the cracks in the system, bringing to light with great clarity how these issues impact different populations.”

Studies have shown that older Black and Hispanic Americans are more likely than their white counterparts to experience multiple chronic health conditions and live in problematic nursing homes. In addition, the study noted, the racial income gap affects their quality of care: limited access to long-term care facilities has led many seniors of color to rely on overburdened family caregivers.

The pandemic hit communities of color harder economically, introducing  further challenges, as communities of color. Further, people of color were more likely to be “essential workers,” increasing COVID exposure, and faced limited access to vaccines.

Accius argued that this circumstance represents an opportunity for a “big reset,” and that reforms are an economic imperative.

“The fact that there are these inequities in our system stifles economic growth, which means that it impacts all of us,” Accius said. “We are interconnected. We’re talking about loss of life, loss of opportunity to contribute, [and the] loss of opportunity to give back. There is an economic cost if we do nothing.”

The article’s 7-step blueprint for building a new long-term care system begins with an assessment of policies, programs, and services, to identify whether inequities exist. Interventions should be tailored to meet vulnerable populations where they are and create an equal playing field, Accius said.

“No community or person wants to be told what their problems are,” he continued. “They want be part of co-creating the solution. It’s critically important to take an asset mindset of the people we are trying to service and understand what they value.”

The researchers emphasized the need for solid data to make the case for change, improved family caregiver support, and partnerships between business leaders, policymakers, and the healthcare industry to advance equity in long-term care services.

So far, Accius said, response to the proposed blueprint has been positive, and he is optimistic that the time is right for change.

“The biggest barrier is the perception that these issues are overwhelming, and they are unsolvable – they are not,” Accius said. “We are seeing different pockets in the country where organizations are coming together to close these gaps. It’s not going to happen overnight, but it’s critically important for organizations to invest their time, talent, and treasure — not just because of our societal values, but [because] the consumer population is becoming more diverse. There’s a business case for this, and the magnitude of the opportunity for impact is limitlessness.”