Project Description Narrative:
The population in Wisconsin is rapidly aging. According to Wisconsin Department of Administration, the number of older adults (those aged 65 years and over) in the state is estimated to increase from 777,314 in 2010 to 1,535,365 in 2040 (the share will nearly double from 13.7% to 23.7%. The estimated increase in the number of the “oldest old”—those aged 85 and over—is even more striking, projected to almost triple from 118,505 in 2010 to 283,600 in 2040, accounting for 4.4% of the total population.
This projected increase in older population highlights the challenge Wisconsin faces in supporting their long-term care (LTC) needs. As the state population ages, prevalence of multimorbidity and functional declines in physical, cognitive, or both, domains will likely increase. Many people will need LTC to help them maintain or improve physical functioning and quality of life. Recent projections estimated that over two-thirds of individuals who reach age 65 will need LTC services during their lifetime and that people currently turning age 65 will need LTC for three years on average. In addition to LTC stress posed by population aging, nearly two dozen nursing homes have closed in Wisconsin since the beginning of COVID-19 pandemic, resulting in a loss of more than 2,000 nursing home beds, according to LeadingAge Wisconsin. Many of these closures occurred in rural areas, adding stress to communities where LTC access is already limited. Despite an urgent need to understand LTC access, utilization and outcome in the state, prior long-term care planning efforts have mostly centered around efficiency and cost control. No prior research has systemically examined the organizational structure of the entire LTC system across Wisconsin and the extent to which access to LTC resources is inequitable across regions and populations.
This project aims to identify LTC deserts in Wisconsin–namely regions and populations with the lowest access to LTC resources–by integrating information on LTC facility type, location, and capacity, LTC service demand, and(or) travel cost (distance). Understanding socio-spatial inequalities in LTC in WI is crucial for several reasons. By identifying and addressing these inequalities, research can contribute to promoting equitable access to LTC for all individuals, regardless of their socioeconomic status, race, ethnicity, or geographical location. Inequalities in LTC access can lead to poorer health outcomes for disadvantaged populations. Research helps shed light on the impact of these inequalities on health and well-being, highlighting the need for targeted interventions and policies to mitigate the negative consequences of lack of access to LTC. By identifying areas and populations with limited access to LTC, research can guide the allocation of funding, the distribution of healthcare facilities, and the provision of services.
As LTC in the state continues to shift from institutional to home- and community-based services (e.g., Wisconsin has both a Certificate-of-Need program and moratorium in place for controlling nursing home bed supplies), this research can identify areas with high LTC needs but low access to home- and community-based LTC and facilitate allocation of home- and community-based LTC services to those areas. Inequalities in LTC access can have economic implications. By understanding the economic impact of these inequalities, policymakers can make informed decisions regarding resource allocation and prioritize interventions that provide the most benefit for the population. Addressing inequalities in LTC can also contribute to the sustainability of healthcare systems by reducing the burden on acute care settings and promoting preventive and community-based care. LTC is a critical aspect of healthcare, particularly for vulnerable populations such as older adults and individuals with disabilities.
By addressing inequalities in LTC access, research can shed light on how inequitable LTC access contributes to disparate caregiver burden across areas and populations within Wisconsin. These insights can be used to generate targeted interventions to better support the caregiver network of persons with chronical diseases and disabilities.