Paid care among older adults with long-term care needs declined in the first year of COVID-19 while families stepped in.

Separate strands of research have documented impacts of the COVID-19 pandemic in nursing homes and among paid and family caregivers, yet there is little evidence connecting changes in the residential decisions of older adults with the provision of paid and family care, limiting our ability to identify potential substitutions and gaps in care. Using the 2020 wave of the Health and Retirement Study linked to county-level COVID-19 mortality rates, we found that, among older adults with long-term care needs, higher county-level mortality rates were associated with a decline in nursing home residence and an increase in co-residence with adult children. These changes were coupled with a decline in the likelihood of receiving paid care and in the number of paid caregivers and an increase in the hours of unpaid care received. This analysis documents a reduction in nursing home residence and paid care during the first year of the pandemic and shows that families filled some of the resulting care gaps. Policymaking around long-term care should consider whether declines in the use of paid care are permanent and how they will affect the health of older Americans and their caregivers over the next decade.