The role of financial difficulty on the health and well-being of adults with functional limitations that may require long-term services and supports

Access to Long-Term Services and Supports (LTSS) is a big concern for many older adults and adults with disabilities who strive to live independently at home. People who have functional limitations that hinder completion of essential day-to-day activities are especially vulnerable to financial difficulty, which may further jeopardize their health and well-being. Using Pearlin's Stress Process Model, this study aims to understand how cumulative financial difficulties proliferate health and well-being among adults who are experiencing various types of functional limitations. This study used the first cycle of data (2019-2020) from the California Long-Term Services and Supports survey, merged with select data from the California Health Interview Survey (N = 2030). Descriptive and multivariable analyses were conducted to test hypothesized relationships. Among adults with functional limitations that may require LTSS, significant indirect associations with cumulative financial difficulties were found across measures of disability status and health and well-being. Experiences of financial difficulty, self-rated health and psychological distress varied by type of disability. People with cognitive impairment experienced more financial difficulties, and more serious psychological distress. People reporting difficulties with activities of daily living or instrumental activities of daily living experienced lower levels of self-rated health. People with multiple types of disability experienced more financial difficulties, lower levels of self-rated health, and more serious psychological distress. These findings can inform the development of targeted policies and practices that alleviate the economic challenges and disparities experienced by adults with diverse functional limitations and ensure that LTSS are more affordable and accessible for all.