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Living arrangements often reflect important quality-of-life indicators for elderly adults. In particular, increased income can prompt changes in household living arrangements for elderly adults. Using a differences-in-differences approach, we examine whether a supplemental income program in Mexico for adults aged 70 and older influenced household size and composition. We compare outcomes at baseline and at six-month follow-up for elderly adults in the treatment group with those in the control group that did not participate in the program. We find that household size increased by 3% in the treatment group relative to the control group. We also find a statistically significant increase in the number of girls aged 6–11 in the household, likely the granddaughters or great-granddaughters of program recipients. Increases in household size were greatest for adults aged 70–79, couples, households receiving two or more supplemental incomes, and households in the top income tercile. Household size did not increase for households of adults aged 80 and older, singles, households with only one supplemental income recipient, and households not in the top income tercile. These results suggest that when older adults have more income, they use part of this income to house their grandchildren.

Immigrants are ineligible for federally-funded Medicaid in the U.S. until at least 5 years after arrival. There is little information on where they receive care in light of this restriction. Using Blinder-Oaxaca decomposition, this study examines whether the setting in which older recent immigrants receive care (i.e., health clinic, emergency room or doctor's office) explains delays in care. Among older adults with a usual source of care, 13.5% of recent immigrants had not seen a health professional in the past year compared to 8.6% of non-recent immigrants and 6.3% of native-born. Approximately 23% of these differences is attributable to recent immigrants' tendency to receive care in clinics and community health centers. Even when older recent immigrants manage to find a usual source of care, it is of lower quality than that received by their non-recent immigrant and native-born counterparts.

Mexicans are the largest immigrant group in the United States of America (USA) and are ageing rapidly. Few studies investigate whether older immigrants return to Mexico for different reasons than younger immigrants. Using the Mexican Health and Aging Study (N = 952), we examine whether Mexican immigrants in the USA who returned to Mexico at age 50 and older report different reasons for returning than those who returned at younger ages. Few immigrants (regardless of age) returned for economic reasons. The most commonly reported reason for returning for both groups was missing family. However, the odds of selecting missing family over illness as their main reason for returning were lower for older immigrants than younger immigrants after controlling for the duration of their stay in the USA and other socio-demographic factors (odds ratio (OR) = 0.27; 95% confidence interval (CI) = 0.11, 0.68). Results indicate that older immigrants were just as likely to report returning due to economic reasons and migration problems as they were to report returning because of illness (OR = 0.57, 95% CI = 0.15, 2.21; OR = 0.41, 95% CI = 0.12, 1.43). While existing research shows that older immigrants in the USA typically experience fewer migration problems and are often more economically stable than younger immigrants, our research suggests this may be entirely due to the duration of their stay in the USA.

Older adults make up an increasing share of new legal immigrants to the United States. These immigrants are often financially dependent on family since they are often barred from receiving several U.S. support programmes and are less likely to receive U.S. retirement benefits than natives. However, little information exists as to whether they receive retirement income from abroad. Using the New Immigrant Survey (N=2,150), we find that only 8.1 per cent of older recent immigrants report receiving foreign retirement income. In logistic modeling, older immigrants from Asia and Latin America were less likely to receive retirement income from abroad than those from Europe (Odds ratio = 0.50, p

For decades scholars have attempted to understand the effects of immigration on the U.S. Social Security system. To date, this research has been primarily limited to migrants in the U.S. and does not consider those who return to their countries of origin. Immigrants often pay OASDI taxes using illegitimate Social Security numbers and may return to their home countries without collecting U.S. Social Security benefits. In this study, we analyze the socioeconomic and labor characteristics, health, migration histories, and transitions to retirement of male Mexican return migrants who contributed to the U.S. Social Security system. Using the 2003 and 2012 Mexican Health and Aging Study (MHAS), we find that in 2012, 32 percent of male return migrants reported having contributed to the U.S. Social Security system but only five percent of those who contributed, received or expected to receive benefits. Those who reported having contributed were more likely to have completed college, spent more years in the U.S., and were more likely to be U.S. citizens or legal permanent residents than those who did not contribute. We also find that return migrants who spent one to nine years in the U.S. had a lower probability of transitioning to retirement between 2003 and 2012 than those had never been to the U.S. In contrast, those who spent 20 or more years in the U.S. had a higher probability of transitioning to retirement.

Older adults comprise an increasing share of new legal admits to the United States. While many are financially dependent on their families, a more complete picture requires taking into account the nonmonetary contributions of this population. Using the American Time Use Survey, this study examines whether older recent immigrant women provide more unpaid childcare than their native-born and more established immigrant counterparts. Results suggest that while older recent immigrant women are more likely to provide unpaid childcare, this effect is eliminated upon controlling for demographic characteristics. However, among those who do provide childcare, older recent immigrant women provide more hours of care even after controlling for demographic and household characteristics. This pattern holds up even after restricting the analysis to women living with young children. These results may signal reciprocal supportive networks. Working-age adults may financially support older recent immigrants, while older recent immigrants provide unremunerated childcare for working-age adults.

Mexicans are the largest immigrant group in the U.S. and are aging rapidly. Data support that many return to Mexico due to economic factors such as employment. Few studies have investigated if older immigrants return to Mexico for different reasons than younger immigrants. Using the Mexican Health and Aging Study (N=963), we examine whether Mexican immigrants in the U.S. who returned to Mexico at age 50 and older report different reasons for returning than those who returned at younger ages. Few immigrants (regardless of age) returned to Mexico for economic reasons. In multinomial logistic regression modeling, older immigrants were more likely to return to Mexico due to illness (OR=3.06, 95% CI=1.29, 7.27) and just as likely to return because they missed family (OR=0.76, 95% CI=0.43, 1.33). Older Mexican immigrants in the U.S. with limited access to health care and/or caregiver support may return to Mexico.

In this study, we examine the factors associated with self-employment for Mexicans close to retirement age, including the role of U.S. migration experience and health insurance. Using cross-tabulation and probit models on a unique source of information, the Mexican Health and Aging Study (MHAS) panel data for 2001, 2003, and 2012, we find that individuals with 1–9 years of U.S. migration experience are more likely to be self-employed than those who had never been to the United States. Moreover, consistent with the literature, we find that self-employed workers are less likely to have health insurance than salaried workers and are also less likely to retire. This may indicate that self-employed workers are more likely to be in the informal sector and not eligible for social security benefits during retirement.

For decades scholars have attempted to understand the effects of immigration on the U.S. Social Security system. To date, this research has been primarily limited to migrants in the U.S. and does not consider those who return to their countries of origin. Immigrants often pay OASDI taxes using illegitimate Social Security numbers and may return to their home countries without collecting U.S. Social Security benefits. In this study, we analyze the socioeconomic and labor characteristics, health, migration histories, and transitions to retirement of male Mexican return migrants who contributed to the U.S. Social Security system. Using the 2003 and 2012 Mexican Health and Aging Study (MHAS), we find that in 2012, 32 percent of male return migrants reported having contributed to the U.S. Social Security system but only five percent of those who contributed, received or expected to receive benefits. Those who reported having contributed were more likely to have completed college, spent more years in the U.S., and were more likely to be U.S. citizens or legal permanent residents than those who did not contribute. We also find that return migrants who spent one to nine years in the U.S. had a lower probability of transitioning to retirement between 2003 and 2012 than those had never been to the U.S. In contrast, those who spent 20 or more years in the U.S. had a higher probability of transitioning to retirement.

International migration has long been considered the preserve of working-age adults. However, the rapid diversification of the elderly population calls for increased attention to the migration patterns of this group and its possible motivations. This study examines whether Latin American immigrants who are primary Social Security beneficiaries are more likely to return to their home countries during later life if they receive lower Social Security benefits. Using a regression discontinuity approach on restricted data from the U.S. Social Security Administration (N=1,515), this study presents the results of a natural experiment whereby the Social Security Administration unexpectedly lowered the Social Security benefits of the 1917-1921 birth cohorts due to a miscalculation in the benefit-calculation formula. Results suggest that approximately 10% of primary Social Security beneficiaries from Latin America born close to these dates return migrated, the probability of which was not affected by Social Security benefit levels.

P184 Introduction: The need to decrease time to treatment for acute stroke patients means that prehospital providers must play an increased role in their care. This is possible only if emergency medical services personnel are able to rapidly recognize and assess patients with neurologic syndromes. Purpose: To assess the performance of a focused neurologic exam by prehospital providers before and after participation in an interactive stroke course. Methods: We developed a 1-day emergency stroke course that consists of 2 hours of lectures and 6 hours of interactive instruction, including small-group sessions led by paramedic instructors as standardized patients (SPs) portraying 5 key neurologic syndromes: left hemisphere, right hemisphere, brainstem, cerebellum, and subarachnoid hemorrhage. We devised a 53-point skills checklist to evaluate paramedic performance of history, exam, management, and emergency department (ED) reporting during 2 pre- and 2 postcourse encounters with actors portraying one of 4 scenarios: left hemisphere stroke, right hemisphere stroke, right hemisphere seizure with postictal hemiparesis, and left hemisphere tumor with sudden worsening. Among the 53 total skills evaluated were 28 exam-related items, including traditional paramedic exam items such as pupil reaction, hand grasp, and foot strength and additional items from the Miami Emergency Neurologic Deficit (MEND) Exam. We randomly selected 46 of 281 learners to participate in the study. Results: Checklist scores for neurologic exam performance improved significantly. The precourse mean score for the 46 learners was 3.38 (12.1%) and the postcourse mean was 21.4 (76.4%) (pConclusions: Paramedics significantly improved their performance of a focused neurologic exam after attending a stroke course utilizing paramedic instructors as SPs with key stroke syndromes. We conclude that prehospital providers can learn and perform a brief, focused neurologic exam after attending a 1-day stroke course that emphasizes hands-on instruction. We are continuing to evaluate the effect of the course on the history-taking, ED-reporting, and stroke-management skills of practicing paramedics.