Adapting Andersen’s expanded behavioral model of health services use to include older adults receiving long-term services and supports

BACKGROUND: Andersen’s Expanded Behavioral Model of Health Services Use describes factors associated with the use of long-term services and supports (LTSS). This model, however, has only been tested on the intent to use such services among African-American and White older adults and not the actual use. Given the increasing diversity of older adults in the U.S., the ability to conceptualize factors associated with actual use of LTSS across racial/ethnic groups is critical. METHODS: We applied Andersen’s Expanded model in the analysis of 2006–2010 qualitative data using multiple methods to understand both the relevancy of factors for older adults who currently use LTSS vs. those who intend to use LTSS (as described in Andersen’s original exploration). We additionally explored differences in these factors across racial/ethnic groups and included Hispanic older adults in our analyses. RESULTS: Four additional constructs linked with actual LTSS use emerged: losses and changes, tangible support, capability to provide informal support, and accessibility of informal support. Racial differences were seen in level of participation in decisions to use nursing home services (Not involved: 45% African-Americans vs. 24% Whites). Reports of LTSS use to avoid burdening one’s family were greater among White older adults compared to African-American older adults. CONCLUSIONS: Findings around decision-making and burden along with other constructs enhance our understanding of determinants that influence actual LTSS use and require targeted interventions.