U.S. Long‐Term Care Infrastructure and Parent‐Child Co‐Residence Among Unmarried Older Adults

ABSTRACT Objective This study examines how variation in the U.S. long‐term care infrastructure shapes the likelihood that unmarried disabled older adults co‐reside with an adult child. Background Older adults with functional limitations often rely on care from their adult children, and co‐residence is one way families organize that care. While individual‐ and family‐level determinants of care‐related co‐residence are well documented, the role of policies and market factors that shape access to paid long‐term care is underexplored. Methods Using a novel dataset that merges individual‐level data from the American Community Survey (2012–2019; N = 906,674) with state Medicaid data and county‐level nursing home and home health availability data, this study estimates fixed effects models to assess the relationship between long‐term care infrastructure and co‐residence. It also tests whether this relationship differs by socioeconomic status and simulates implications for socioeconomic inequalities in co‐residence. Results More abundant long‐term care infrastructure is associated with a lower likelihood of co‐residence, particularly among older adults with lower levels of education. Simulation results suggest that a 25% improvement in long‐term care infrastructure corresponds to a 12% decrease in socioeconomic inequalities in co‐residence. Conclusion Findings suggest that intergenerational living arrangements are responsive to policy and provider availability factors shaping access to paid long‐term care. Insufficient long‐term care infrastructure environments may enforce family obligations to co‐reside, especially among lower socioeconomic‐status families.