Stipica Mudrazija

How Do Race and Hispanic Ethnicity Affect Nursing Home Admission? Evidence From the Health and Retirement Study

OBJECTIVES This study investigates how health- and disability-based need factors and enabling factors (e.g., socioeconomic and family-based resources) relate to nursing home admission among 3 different racial and ethnic groups. METHOD We use Cox proportional hazard models to estimate differences in nursing home admission for non-Hispanic whites, non-Hispanic blacks, and Hispanics from 1998 to 2010 in the Health and Retirement Study (N = 18,952). RESULTS Racial-ethnic differences in nursing home admission are magnified after controlling for health- and disability-based need factors and enabling factors. Additionally, the degree to which specific factors contribute to risk of nursing home admission varies significantly across racial-ethnic groups. DISCUSSION Our findings indicate that substantial racial and ethnic variations in nursing home admission continue to exist and that Hispanic use is particularly low. We argue that these differences may demonstrate a significant underuse of nursing homes for racial and ethnic minorities. Alternatively, they could signify different preferences for nursing home care, perhaps due to unmeasured cultural factors or structural obstacles.

The balance of intergenerational family transfers: a life-cycle perspective

The aim of this study is to determine the likelihood and net amount of parent–child transfers over the adult life cycle across European welfare regimes. The study introduces an economic life-cycle model of family transfers to describe the evolution of family exchanges across generations over time, which reveals a nonlinear relationship of age and net family transfers. Furthermore, it refines the method of estimating parent–child net transfers. Data come from the Survey of Health, Ageing, and Retirement in Europe, and include 36,095 parent–child dyads from 11 European countries representing social democratic, conservative, and traditional welfare-state regimes. The findings reveal net value of family intergenerational support follows a nonlinear pattern across the adult life cycle, with positive transfers from parents to adult children decreasing modestly until advanced old age when the decrease intensifies. Net family support benefits individuals and generations with larger relative need. The transition in the net family support pattern starts later and is less pronounced across social democratic welfare-regime countries while the opposite is true in traditional welfare-regime countries. These findings might be interpreted as being linked to differences in the public policies guaranteeing different levels of provision for dependent populations across different welfare regimes. They are consistent with a comparatively smaller role of family support in the intergenerational redistribution of resources in societies with larger public intergenerational support to dependent populations.

Public transfers and the balance of intergenerational family support in Europe

ABSTRACT To capture the simultaneity of changes in different types of family transfers and describe the pattern of rebalancing of intergenerational family support in response to variation in public support, it is important to study bidirectional flows of resources between family generations. This study uses data on 13 European countries to estimate the net value of transfers between parents and adult children and to determine the relationship of the net value of family transfers with public intergenerational transfers. Individual-level data come from the Survey of Health, Ageing, and Retirement in Europe, and are supplemented with the country-level information from the Organisation for Economic Co-operation and Development, United Nations, and national statistical offices. Multilevel models are estimated to account for the nested structure of data. The results suggest that the needs of parents and children and their ability to provide support are important determinants of the flow of net transfers between parents and children. Public intergenerational transfers to the generation of older parents and/or their adult children are associated with a secondary redistribution of support at the family level from persons belonging to the generation that benefits relatively more from public transfers to those belonging to the other generation.

Binational Migration Perspectives: Mexico, Latin America, and the USA

Our understanding of the migration processes can be substantially improved by examining the “contexts of premigration experiences” including the environmental conditions that motivated migration and personal preparedness to facilitate the physical transition as well as the “contexts of reception” such as structural factors and social resistance to migrants encountered in local areas of resettlement. This section of the volume connects the worlds of migrating and non-migrating people of Mexican heritage in the U.S. and Mexico, and examines selected issues accompanying consequences of resettlement and rebuilding lives and lifestyles. The chapters reflect major domains of transnational research in aging: impacts of migration and social adjustment, processes of support in families and social networks, and the impact of changing demography and residential status for foreign-born migrants in the U.S. The studies presented in this section benefit from a higher quantity and quality of cross-sectional and longitudinal survey data to study migratory patterns and regional variation in resettlement, differences in societal integration, and the connection of these patterns with health and healthcare.

Household Composition and Longitudinal Health Outcomes for Older Mexican Return Migrants

Mexican return migrant population is increasing, yet our knowledge about their lives after resettlement in Mexico remains fragmentary. Using 2001–2012 longitudinal data from the Mexican Health and Aging Study, we investigate difference in household composition for older migrants who returned from the United States compared to nonmigrants. Furthermore, we fit a Cox proportional hazards model to assess the relationship between household composition and health and functional trajectories of return migrants and nonmigrants. The results indicate that return migrants with long duration of U.S. stay have different household composition than nonmigrants or short-term migrants: On average, they have smaller household size, including fewer females who may be available to offer assistance to older adults. Presence of middle-age females in the household has positive effects on health and functional trajectories. We highlight implications of this research for policy makers in Mexico and the United States.

Older Latinos’ Financial Security: Resources, Needs, and Future Prospects

This study assessed Latinos’ retirement security, including their financial resources and retirement needs, showing past trends and future prospects. Using data from the American Community Survey, decennial censuses, and Health and Retirement Study, tabulations compared poverty rates, income and wealth, health and disability, relationship status, and household composition for Latinos and non-Latinos ages 65 and older. The Urban Institute’s Dynamic Simulation of Income Model also projected income and wealth for future generations. The results show that older Latinos receive less income, hold less wealth, and are more likely to be impoverished than older non-Latino whites. Financial outcomes are significantly worse for older foreign-born Latinos than for those born in the United States. However, projections indicate that the gaps will narrow somewhat in coming decades. Various policy options, such as workforce development initiatives, efforts to promote education and retirement savings, and Social Security reforms that increase benefit progressivity could improve financial security for future Hispanic retirees.

Homeownership, Social Insurance, and Old-Age Security in the United States and Europe

Relatively few Americans have accumulated substantial savings outside of their employer-sponsored retirement plans, yet most own their homes. The traditional view of the retirement income system as a three-legged stool supported by Social Security, private pensions, and savings may be better viewed as being supported by Social Security, pensions, and homeownership. Country-specific economic, social, and political developments throughout modern history mean that homeownership rates and the relative importance of homeownership for old-age security vary widely across developed countries. Many countries, however, are increasingly promoting homeownership as an effective way of building assets, a de facto self-insurance mechanism for old-age security, and a substitute for various social transfers. This paper uses data from the Health and Retirement Study (HRS) and the Survey of Health, Ageing, and Retirement in Europe (SHARE) to better understand the role of homeownership in retirement before and after the Great Recession for the United States and nine Western European countries: Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, and Sweden. It begins by comparing trends in homeownership rates among older adults and the key characteristics of housing-related policies and regulations that potentially impact home acquisition. It then examines home equity trends, the prevalence and burden of housing debt, and the relative importance of housing as a source of retirement wealth. Next it provides an overview of equity release options and estimates how much older households could increase their incomes by fully monetizing their housing equity. Finally, the paper discusses the prospects for and limits of home equity release and asset-based welfare policies. The paper found that: -Most older adults are homeowners, and homeownership rates generally increased between 2006 and 2012; however, there is substantial variation across countries. -Housing-related policies in the Netherlands, Sweden, and Denmark provide comparatively high levels of support to both homeowners and non-homeowners, while those in Italy and Spain provide little support to either group. In contrast, housing policies in the United States provide some of the highest levels of support for homeowners and lowest levels of support for non-homeowners. -Older American homeowners have substantial housing wealth, but compared with their European peers, housing represents a somewhat smaller part of their net total wealth. -While the prevalence of housing debt among older adults is somewhat lower in the United States than in the Netherlands, Denmark, and Sweden, among older homeowners with housing debt, Americans have the highest loan-to-value ratios and the highest proportion of homeowners whose homes may be at risk of going underwater. -If the housing equity of older Americans were completely monetized, median household income would increase by over a third – more than in countries like Sweden and Denmark, but well below countries like Spain and Italy. Across all countries in this study, tapping into housing equity could substantially reduce the share of older adults with household incomes below 50 percent of the median – the threshold for relative poverty. -However, even after annuitizing housing wealth, the share of poor older Americans would remain as high as, or higher than, the share of poor older Europeans before accounting for annuitized housing wealth. -Despite the potentially large impact of monetizing home equity on household incomes and the economic security of older Americans and Europeans, there remain impediments to tapping into home equity that may explain its low use. Objective obstacles include the high costs of withdrawing housing equity, uncertainty about life expectancy and the amount of financial resources required to support retirement, the adverse impact on eligibility for social benefits, and the concentration of housing wealth among (upper) middle- and higher-income individuals who are less likely to need additional resources in old age. Subjective obstacles include an aversion toward assuming additional debt in old age, different (often emotional) attitudes to housing compared with other types of wealth, bequest motives, and a lack of trust in financial institutions. The policy implications of the findings are: -Home equity has a potentially important yet limited role in supporting old-age security. Even if objective obstacles related to the design and pricing of home equity release products were fully addressed, subjective reasons for avoiding home equity withdrawal and compositional differences in the concentration of housing wealth would still limit the scope of asset-based welfare. -These limitations notwithstanding, using home equity to supplement retirement incomes and improve retirement security remains a potentially attractive option for a substantial number of older adults who have built housing wealth over their life course, but may either have insufficient retirement incomes or face unexpected and expensive life events (e.g. long-term care needs). -What remains more uncertain and difficult to predict, though, are the long-run prospects for using home equity to support old-age security since younger generations of Americans and Europeans may find it more difficult to build home equity than their parents’ generation.

Hispanics’ Retirement Transitions and Differences by Nativity

Objective: This study examines differences in retirement decisions between older Hispanics and non-Hispanics, with a special focus on the role of nativity. Methods: We use 1998-2012 waves of the Health and Retirement Study. We estimate survival models of retirement and compare retirement transitions for U.S.-born Hispanics, foreign-born Hispanics, non-Hispanic Whites, and non-Hispanic Blacks. Results: Foreign-born Hispanics retire significantly later than other racial and ethnic groups. Controlling for personal characteristics, their risk of retirement is 39% lower compared with non-Hispanic Whites. Retirement transitions do not differ significantly between U.S.-born Hispanics and non-Hispanic Whites. Discussion: Difference in retirement timing between U.S.- and foreign-born Hispanics may partly be due to lower incomes and wealth accumulation of foreign-born Hispanics. Workforce development initiatives, policy initiatives promoting retirement savings, and Social Security reforms could improve future retirement security for older Hispanics, and make retirement a viable option for more foreign-born Hispanics.

Racial and Ethnic Inequalities in Health

The population is aging in both the developed and developing world, and the United States is no exception. It is well established that Americans are living longer. US life expectancy at birth increased from 70.8 in 1970 to 78.7 in 2010. For those aged 65, remaining life expectancy rose from 15.2 years to 19.1 years over the same time period. Perhaps most importantly, and the focus of this chapter, as the nation grows older it is rapidly becoming more racially and ethnically diverse. Currently, there is less racial/ethnic diversity in the population 65 and older than among younger Americans. However, the older population is expected to be 42% minority by 2050 (US Census Bureau, 2011). The dual trends of increased life expectancy and the growing diversity of the aging population raise important theoretical and practical questions about race-based inequalities in health and their consequences for health care spending in light of projected deficits in Medicare.