The Availability of Care for Late-Middle-Aged Adults With Chronic ...

They found that the lower level of unmet need among elderly persons compared with working-aged adults was almost perfectly complimented by an increased level of use of state-supported transportation and nutrition services. What little is known about the care networks of working-aged individuals is that they rely less upon formal services than their elderly counterparts (LaPlante, Harrington, & Kang, 2002).

In addition, racial/ethnic minority status and divorce are both positively associated with unmet need for care, as is a lack of Medicare and/or Medicaid coverage (Lima & Allen, 2001). Those who perceive their support network to be less resilient to their needs, and those who have fewer children living nearby are also at greater risk of unmet need for care (Mor, Allen, Siegel, & Houts, 1992).

Both regional and national studies of adults with disabling conditions have found that fully one-third to one-half of people experience one or more adverse consequences associated with inadequate care in a month’s time that have implications for health status and service utilization. Adverse consequences include falls, burns, going hungry, inability to follow special diets, weight loss, dehydration, wetting or soiling self, missing physician appointments, and depression (Allen & Mor, 1997; Desai, Lentzner, & Weeks, 2001; Komisar, Feder, & Kasper, 2005; LaPlante et al., 2004). Inadequate care is also associated with hospitalization and emergency room use (Long, King, & Couglin, 2005–2006; Sands et al., 2006).

There is evidence suggesting that public policies can reduce unmet need in populations with long-term care needs. A survey of dual enrollees in Medicare and Medicaid in six states revealed high levels of unmet need overall (58% of respondents with long-term care needs). However, lower levels of unmet need for ADL assistance were observed in states in which a higher proportion of people received paid care (Komisar et al., 2005).