Changes in Long-term Services and Supports Among Adults with and without Dementia During the First Year of the COVID-19 Pandemic

Background and Objectives
This study draws upon local COVID-19 mortality rates as a proxy for pandemic severity to determine if the COVID-19 pandemic disrupted long-term services and supports (LTSS) for adults with dementia, relative to adults with care needs unrelated to dementia.

Research Design and Methods
We used the Health and Retirement Study to estimate associations between local COVID-19 mortality rates from March 2020 through April 2021 and LTSS outcomes (receiving paid and unpaid help, monthly hours of paid and unpaid help, number of paid and unpaid helpers, living in a residential care setting, or living with adult children). We compared two groups of adults ages 51 and older: those with dementia (n=522) and those without dementia but having difficulty with at least one Activity of Daily Living (n=2,036).

Results
We found that higher local COVID-19 mortality rates were associated with a reduction in paid care and living in residential care settings for both groups of adults with care needs. In addition, higher local COVID-19 mortality rates were associated with a greater likelihood of living with adult children among those without dementia and greater hours of unpaid help among those with dementia.

Discussion and Implications
While we did not find differences in disruptions of LTSS between persons with and without dementia, observed declines in paid LTSS and increases in unpaid care in the first year of the pandemic may nevertheless have different implications for persons with dementia. Future research should investigate if COVID-19 related disruptions in LTSS led to differential changes in health and unmet need among adults with dementia, increased strain for their caregivers, and the equitable availability of high-quality paid care.