Based on the H-EPESE study, age, functional status, male gender, and cognitive impairment were the primary predictors of institutionalization of Latino elderly (Angel, Angel, Aranda, Miles, 2004). In a National Mortality Followback Survey there were similar proportion of non-Hispanic white and Latinos died in nursing homes and were less likely to die in a private home (Iwashyna & Chang, 2004.
Yet another study found that Latinos experiencing more benefits or “uplifts” impeded institutionalization over an 11-month period compared to their Caucasian sample of elderly (Mausbach, Coon, Depp, Rabinowitz, Wilson-Aria, Kraemer et al, 2004).
More recent data on predictors of institutionalization among Latinos were determined in part to the well-being of the caregiver. Caregivers reporting greater depression and increased care provision were more likely make decisions toward institutionalization (Gaugler, Kane, Kane, Newcomer, 2006). Gaugler, et al., 2006 reported that obtaining Medicaid also facilitated the institutionalization process for Latinos. Historically preferences for family care and lower utilization of formal long-term care services has been examined in the literature on chronic illness management among Hispanic/Latino populations (Gaugler, et al., 2006; Villa et al., 1993).
Use of in-home care services was found by Wallace and Lew-Ting (1992) to be twice as high among Puerto Ricans as other older Hispanic populations, which they suggested might be related to the well-developed network of services in New York City compared to rural areas where many Mexican American elders live. Fewer older Hispanics use nursing home care than other older Americans and those that do are more likely to be younger and more impaired (Villa et al., 1993).
The most common explanations for the differences in utilization have been cultural preference and availability of, and feelings of obligation by family caregivers. An exploratory study describes caregiving experiences by 8 MA women and explores their attitudes about elder care (Clark, & Huttlinger, 1998). A rich cultural heritage includes the importance of the family’s responsibility to care for its elder members and describes family commitments that reach beyond obligation.
Cultural Aversion Hypothesis
One misinterpretation of the availability of family care is that “they take care of their own, so no support services are needed.” Some have called this the Cultural Aversion Hypothesis, meaning that Hispanic/Latino families have an aversion to the use of long-term care services. In reality, Hispanic families experience the stressors that any family caregivers face, and the need for culturally acceptable services supporting the families are crucial.