Medicare beneficiaries who are Black or Latino are more likely than white beneficiaries to report difficulty with two or more activities of daily living (ADLs), a new report has found.
The report’s analysis was conducted by ATI Advisory, a healthcare research and advisory services firm, alongside the Robert Wood Johnson Foundation. It aimed to understand the characteristics and experiences of Medicare beneficiaries with ADLs and to highlight disparities with the goal of informing policy.
The analysis used 2017-20 data from the Medicare Current Beneficiary Survey related to beneficiaries living in the community and not nursing homes, assisted living or other institutions. Nearly two-thirds of Latino beneficiaries are fully or partially eligible for Medicaid, compared to half of Black beneficiaries and a quarter of white beneficiaries, the report found.
ADLs are fundamental daily tasks performed by individuals to take care of themselves, defined by Medicare as dressing, bathing, walking across the room, transferring in and out of bed or a chair, using the toilet and eating. Without adequate support, individuals with difficulty with ADLs may face increased risk of accidents, falls, burns, medication errors and isolation.
Nearly one-fifth (19%) of Black Medicare beneficiaries reported difficulty with two or more ADLs, according to the report. More than one-fifth (21%) of Latino beneficiaries reported the same, while 14% of white beneficiaries reported difficulty.
“Automatically, this becomes a racial and ethnic issue,” Laura Benzing, an ATI Advisory analyst who worked on the report, told Fierce Healthcare.
At the same time, Black and Latino beneficiaries are more likely to receive help with ADLs. “It could be a strength of the communities that they are relying on for caregiving support,” Benzing noted.
Black and Latino beneficiaries are more likely than white beneficiaries to report experiencing social determinants of health such as low income, food insecurity and low rates of high school graduation. These individuals “may benefit from targeted interventions that address socioeconomic disparities and create accessible systems that align with personal preferences and cultural differences,” the report said.
Black and Latino beneficiaries are also more likely than white beneficiaries to report relying on helpers younger than 65 and relying on a non-spousal female relative for caregiving support.
“These are individuals who may be more likely to have to sacrifice a job or make economic sacrifices to provide that support,” Benzing said, encouraging payers and states to consider this when providing options for caregiving support.
Black and Latino beneficiaries are less likely to report being currently married than white beneficiaries. Marriage or partnership can provide support for ADLs. Despite these differences, beneficiaries are similarly likely to report living along across race and ethnicity. Beneficiaries who live alone may need services to address social isolation and personal emergency response support, the report said.
Among those reporting difficulty with ADLs, emergency department visits, hospital utilization and Medicare spending is relatively consistent across all races and ethnicities at an average prevalence of 30%, 25% and 33%, respectively.
Black beneficiaries are less likely than white beneficiaries to report difficulty getting to the doctor and are also less likely to report mental health conditions. Rates for the latter could be influenced by someone’s willingness to self-report, per the report.
But Black beneficiaries are more likely to report problems paying medical bills than Latino and white beneficiaries.
When it comes to vaccinations, Black and Latino beneficiaries reporting difficulty with ADLs are less likely than white beneficiaries to report receiving the flu and shingles vaccines. Improving vaccine access and preventive care is key to helping address inequities, the report noted.
Similar COVID-19 vaccination rates among Black, Latino and white beneficiaries can serve as a lesson for other vaccination campaigns.
Overall, dual-eligible beneficiaries with ADL needs may have different experiences than the Medicare-only population, because Medicaid covers long-term services and supports while Medicare does not. While there are limits, states can also use Medicaid to address social determinants of health, Benzing said. There are opportunities to coordinate benefits and address ADL inequities across both programs.