Factors affecting the unmet long term care need of elderly in Korea and the United States: Effects of children and formal home care on the unmet need

This study explores factors affecting the unmet long term care need of elderly persons in Korea and the U.S. In particular, it examines the effect of the presence of children in the home, as well as the effect that formal home care has on the reported unmet needs of the population. Data from the 1994 Elderly Living Condition Survey (ELCS) is used to analyze the Korean model, and the 1994 National Long Term Care Survey is used to analyze the U.S. model. The unmet need is defined as the gap between the amount of long term care need, as assessed by an individual, and the actual resources the individual has at his/her disposal to meet that need. Predictors for unmet need models for both surveys show an extensive similarity, in that high levels of functional difficulties and being in advanced age group are factors that are related to unmet need. Especially, living with a child is the most influential predictor in both models. But, Living with a Child models present somewhat different predictors that are significant. One is that physical limitations are not significant predictors in the ELCS model. The other is that having a daughter is the most influential predictor for the NLTCS, whereas having a son is for the ELCS. The finding indicates that Korean elderly living with a child is a matter of fact rather than a health related decision. Further examination of the relationship between unmet need and different types of living arrangements, number of children and household members, found high fluctuation in the unmet need rate in the ELCS, depending on the living and the family situation, and very consistent rates in the NLTCS. This finding suggests that the Korean elderly have to live in certain types of living arrangements in order to meet the needed care, whereas the U.S. elderly can meet the need, to a certain extent, regardless of the living arrangement. This could be the result of Korea not having structured formal home care, where the only way to meet the need is to live with certain types of informal caregivers. In contrast, the U.S. elderly can either supplement or substitute the needed care with formal home care services. Thus, the impact and the need of formal home care can be seen from the differences shown in these two countries