Risk of Nursing Home Admission Among Older Americans: Does states' spending on home and community-based services matter?

Objectives. States vary greatly in their support for home and community-based services (HCBS) that are intended to help disabled seniors live in the community. This paper examines how states' generosity in providing HCBS affects the risk of nursing home admissions among older Americans and how such effects are moderated by family availability. Methods. We conducted discrete time survival analysis of first long-term (90 days) nursing home admission that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier. Results. State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p .001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 would reduce the risk of nursing home admissions among childless seniors by 35 percent. Discussion. Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost-effectiveness.

Home Care Services/Nursing Homes/Health Policy/Elderly

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