Addressing Long-Term Care Inequities: Dr. Wei Xu’s Mission to Bridge the Gap

As Wisconsin’s population continues to age, the state faces mounting challenges in providing equitable long-term care (LTC) resources for older adults. According to the Wisconsin Department of Administration, the number of residents aged 65 and older will nearly double from 777,314 in 2010 to more than 1.5 million by 2040.

Even more striking, the “oldest old,” those aged 85 and above, will triple in number, accounting for 4.4% of the total population. This demographic shift underscores an urgent need to address gaps in LTC services, which are critical for maintaining physical functioning and quality of life in older adults.

The need for LTC is widespread. Over two-thirds of individuals who reach age 65 are expected to require LTC services during their lifetime, with an average of three years of care needed per person. Yet, Wisconsin’s LTC infrastructure is struggling to keep up. Since the onset of the COVID-19 pandemic, nearly two dozen nursing homes have closed, leading to the loss of more than 2,000 beds. This strain is felt most acutely in rural areas, where LTC access is already limited, creating what researchers call “LTC deserts.”

Amid these challenges, Wei Xu, PhD, assistant professor in the Division of Epidemiology and Social Sciences at the Institute for Health & Humanity, is at the forefront of tackling LTC inequities. A spatial epidemiologist, Dr. Xu leverages his expertise in geography and public health to explore how place-based factors affect health outcomes over the life course. His latest project, “Identifying Long-Term Care Deserts in Wisconsin,” is funded by a $50,000 grant from the Advancing a Healthier Wisconsin Endowment.

“Neighborhoods with a higher concentration of older adults often have fewer long-term care facilities,” Dr. Xu says. “There’s a mismatch between where the needs are and where the resources are.”

Mapping the Gaps

Dr. Xu’s project aims to pinpoint regions in Wisconsin with limited LTC resources. By integrating data on LTC facility types, locations, capacities, and travel distances, the research team is creating a comprehensive map of LTC access across the state. This map will not only highlight LTC deserts but also guide future planning and resource allocation.

Preliminary findings reveal stark disparities. Counties in northern Wisconsin – such as Sawyer, Price, and Forest – are among those identified as LTC deserts. Even in the state’s southern regions, pockets of limited access exist in areas like Green and Lafayette counties. Overall, 7% of older adults in Wisconsin live in residential LTC deserts, 19.8% live in non-residential LTC deserts, and 4.4% live in both. Notably, neighborhoods with higher percentages of older residents often face the greatest challenges, indicating a troubling mismatch between demand and supply.

Dr. Xu notes that this work is not just about identifying deficits but also about understanding the broader implications.

“Inequalities in LTC access can lead to poorer health outcomes for disadvantaged populations,” he says. “By addressing these disparities, we can promote equitable access to care for all individuals, regardless of their socioeconomic status or geographical location.”

A Data-Driven Approach

Dr. Xu’s research reflects his broader commitment to integrating data and geography in addressing health disparities. His previous work has examined the effects of neighborhood disadvantage on biological aging, as well as the interaction between physical activity and air pollution in influencing dementia risk. In his view, geography offers a unique lens through which to understand and address public health challenges.

“I approach public health issues from a geographic perspective,” he explains. “Place matters–where people live, the resources they have access to, and the environments they’re exposed to all shape health outcomes over time.”

The LTC project embodies this ethos by combining spatial analysis with a focus on social determinants of health. In addition to identifying LTC deserts, with the help from the GEO Shared Resource at the MCW Cancer Center, Dr. Xu’s team has developed an interactive web mapping tool that will allow residents to identify nearby LTC facilities and visualize statewide disparities. This resource aims to empower communities and policymakers alike.

“We’re building an online map so people can type in their home address and see all the available long-term care facilities near them,” Dr. Xu says. “This transparency is crucial for both individual decision-making and systemic change.”

Addressing Systemic Inequities

Wisconsin’s LTC landscape is shifting, with a growing emphasis on home- and community-based services. Dr. Xu’s research highlights the importance of ensuring these services are distributed equitably. By identifying areas with high LTC needs but low access, the project can inform policies that allocate resources more effectively.

The implications extend beyond individual health outcomes. Inequities in LTC access can exacerbate caregiver burdens, strain healthcare systems, and contribute to economic disparities. By shedding light on these systemic issues, Dr. Xu’s work offers a pathway toward more sustainable and inclusive healthcare solutions.

His passion for geography and public health stems from his unique academic journey. He earned an undergraduate degree in geographic information science and pursued graduate education in medical geography. For him, the intersection of these fields offers endless opportunities to address pressing societal challenges in public health.

“Addressing LTC inequalities isn’t just about improving access – it’s about creating a more equitable and resilient healthcare system,” Dr. Xu says. “This research can guide interventions that benefit the entire population, particularly the most vulnerable."