Determinants of utilization of services to the elderly: A political economy perspective.

Abstract

This dissertation asked if access to and utilization of social services to the elderly varies by racial/ethnic group and service type. It posed institutional and societal, as well as individual, predictors as influences on utilization behavior. From a political economy perspective, Whites, Blacks, Hispanics, and Native Americans, are compared and shown to have differing access to, as well as utilization patterns of services. The Anderson and Newman model tests predictor variables found in other research to be related to service use, plus a composite measure of kin availability and contextual measures taken from archival records of aging agencies. The data used in this study were from multiple sources, including the Michigan Office of Services to the Aging Statewide Needs Assessment (1985), two subsequent studies using the same instrument: Hispanics 60 and Over (1987) and Native Americans 55 and Over (1989); contextual data were obtained from archival records and census reports. Records used in measuring the contextual data, including minority participation in programs, were found inadequate. Multiple regression analysis showed that conditions affecting service use among minority and majority elderly differ markedly. Predictors also differed between the two types of service examined: In-Home and Community. Results show that the route to service use is more diffuse and less predictable for Whites. Whites were shown to utilize services proportionally less than minorities and less of the variance was explained in all of the White models. Contextual factors were much less important for Whites than for the minority groups. The percent elderly living in an area, richness of the service environment, and the current make-up of users all had stronger influences on the three minority populations. Enabling and contextual factors are stronger predictors of both knowledge and use for the minority populations than for Whites. The most consistent enabling predictors of use of both types of service were knowledge of the service and having community ties through other agency contacts and/or belonging to clubs. Finally, this research examines the effect of age on need and use, questioning the equity of a chronological definition of when "old age" begins.