2. Physician-Based Factors: Long-Term Care
African American older adults are frequently supported in adhering to their health care regimens by family members rather than formal support providers. Family members also act as coordinators of care, including transportation, medication management, diet, exercise and monitoring chronic illness (Jennings, 1999).
This is further supported by the fact that most African Americans with functional disabilities and health problems remain at home, with supportive care provided by immediate or extended families and informal support networks in the church or community. Past experiences of Black older adults have demonstrated that utilization of institutions for the purpose of “rehabilitation,” rather than as nursing homes was more common (Mavundla, 1996). Lower rates of institutionalization by older African Americans have been accounted for by higher use of paid home care, informal-only care or no care (Wallace et al. 1998).
In 1999, data was released by the National Center for Health Statistics that for the first time showed nursing home utilization by African Americans equal or greater than that by older White Americans in most age and sex categories (See Figure 2). In all of the three age groups of older men, and in all but the oldest women, a higher proportion of Black older adults resided in nursing homes.