Objectives. We examined whether older individuals living with same-sex partners face greater risks of needing long-term care than their counterparts living with different-sex partners or spouses. Methods. With data on older couples (at least 1 individual aged 60 years or older) from the 2009 American Community Survey, we estimated logistic regression models of 2 activity limitations that signal a long-term care need: difficulty dressing or bathing and difficulty doing errands alone. Results. When we controlled for age, race/ethnicity, and education, older women who lived with female partners were statistically significantly more likely than those who lived with male partners or spouses to have difficulty dressing or bathing. Older men who lived with male partners were statistically significantly more likely than those who lived with female spouses or partners to need assistance with errands. Conclusions. Older individuals living with same-sex partners face greater risks of needing long-term care than those living with different-sex partners or spouses, but the role of relationship status differs by gender. These findings suggest more broadly that older gay men and lesbians may face greater risks of needing long-term care than their heterosexual counterparts.

Over one million Americans aged 15 years and older are deaf or hard of hearing. These individuals may face barriers to and within the labor market, leading to lower employment rates and reduced earnings compared with their counterparts without a hearing disability. Our study contributes to the sparse literature on the relationship between hearing disability and labor market outcomes by examining “hearing earnings gaps,” namely, earnings gaps between individuals who are deaf or hard of hearing and their counterparts without a hearing disability. Using a sample of 25- to 40-year-old full-time year-round workers from the 2011 American Community Survey, we estimate separate earnings equations by hearing ability and gender using generalized estimating equations. For both men and women, Blinder–Oaxaca decompositions indicate that roughly 40% of the overall hearing earnings gap is attributable to differences in educational attainment, potential experience, race/ethnicity, and marital status. The remaining 60% may reflect differences in communication skills and other unobservable characteristics, occupational segregation, labor market discrimination, and stigma.

With data from the Assets and Health Dynamics Among the Oldest Old Survey, we estimate dynamic models of three dimensions of families’ elder-care arrangements: the use of each potential care arrangement, namely care provided by a spouse, care provided by an adult child, formal home health care, and/or institutional care; the selection of the primary care arrangement; and hours in each care arrangement. Our results indicate that both observed heterogeneity and positive true state dependence contribute to the persistence of care arrangements. Evidence of positive true state dependence for most or all modes of care in all models suggests that inertia generally dominates caregiver burnout. Our results indicate that formal care decisions depend on the cost and quality of care. As a result of inertia, the effectiveness of long-term care policy depends on timing: initial caregiving decisions are more sensitive than subsequent decisions to economic incentives.

The World Health Organization classifies combined hormonal contraception as an unacceptable health risk in the presence of a known thrombogenic mutation but advises against routine thrombophilia screening before initiating combined oral contraceptives (COCs) on the grounds of high screening costs and low prevalence. From the perspective of patient-centered care, we examine cost, prevalence, and other published arguments for and against thrombophilia screening before initiating COCs. Our patient-centered review draws on relevant empirical evidence concerning the advantages and disadvantages of thrombophilia screening, while placing the discussion in the broader context of evolving attitudes toward genetic testing and a shifting policy landscape that provides many women direct access to COCs and/or thrombophilia screening. Given variation in prior probabilities of thrombophilia, expected exposure to other risk factors for venous thromboembolism, attitudes towards risk, expected reactions to a positive test result, ability to pay, and concerns about genetic discrimination, we conclude that the current one-size-fits-most approach is not consistent with patient-centered care. Instead, we advocate for greater patient and provider education concerning the implications of thrombophilia screening. Moreover, we recommend offering patients optional thrombophilia screening before initiating COCs.