Which came first, the closed nursing home or the doubled-up household?
The recession-driven spikes in multigenerational households and cohabiting couples are making families feel the love a little more proximately. These are spikes in longer-term trends; another one is the race and class disparity in reliance on nursing home care.
And in the last 10 years the people who use nursing homes more have disproportionately experienced the closure of local facilities, according to a new analysis in the Archives of Internal Medicine.
The authors analyzed the closure of almost 3,000 nursing facilities - a little more than half of them free-standing nursing homes - between 1999 and 2008, for a loss of about 5% of all nursing care beds.
They conclude:
The relative risk of closure was significantly higher in zip code areas with a higher proportion of blacks or Hispanics or a higher poverty rate. ... Closures tended to be spatially clustered in minority-concentrated zip codes around the urban core, often in pockets of concentrated poverty.
The findings are nicely illustrated in this figure from Chicago, showing closures (red triangles), remaining facilities (black dots), and racial composition (darker blue = higher minority composition):
In practical terms, this means poor people, Blacks and Latinos in urban areas are more likely to live further from the nearest nursing care facility:
...in zip codes in which at least 1 nursing home closed from 1999 through 2008, the nearest distance to an operating facility increased from 2.73 miles in 1999 to 3.81 miles in 2008... In contrast, this distance was shortened slightly in zip codes without any nursing home closure... Similarly, in the poorest quartile of zip codes (ranked by poverty rate), this nearest distance increased by 10.4%, from 3.45 to 3.81 miles.
Most people doubling up or moving in together because of economic constraints probably aren't responding to a lack of nursing home care. But both trends are indicative of the intermingling (geographic, economic and otherwise) of care needs, housing needs, economic insecurity and family relationships.
Cross-posted from the Family Inequality blog.