@article {7241, title = {Place of death among older Americans: does state spending on home- and community-based services promote home death?}, journal = {Med Care}, volume = {46}, year = {2008}, month = {2008 Aug}, pages = {829-38}, publisher = {46}, abstract = {

BACKGROUND: The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals{\textquoteright} circumstances largely determine where they die, health policies may affect the range of options available to them.

OBJECTIVE: To examine whether states{\textquoteright} spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals{\textquoteright} family, sociodemographic, and health factors.

METHODS: Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states{\textquoteright} HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community.

RESULTS: Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death.

CONCLUSIONS: States{\textquoteright} generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Death, Humans, Logistic Models, Nursing homes, Residence Characteristics, Terminal Care}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e3181791a79}, author = {Muramatsu, Naoko and Ruby L Hoyem and yin, Hongjun and Richard T. Campbell} } @article {7138, title = {Risk of nursing home admission among older americans: does states{\textquoteright} spending on home- and community-based services matter?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S169-78}, publisher = {62B}, abstract = {

OBJECTIVE: 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 article examines how states{\textquoteright} generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects.

METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.

RESULT: 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 or older would reduce the risk of nursing home admission among childless seniors by 35\%.

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.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cohort Studies, Cost Savings, Cost-Benefit Analysis, Female, Financing, Government, Health Expenditures, Home Care Services, Homes for the Aged, Humans, Insurance Coverage, Long-term Care, Male, Medicaid, Medicare, Nursing homes, Patient Admission, Patient Readmission, Risk Assessment, Risk Factors, State Health Plans, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s169}, author = {Muramatsu, Naoko and yin, Hongjun and Richard T. Campbell and Ruby L Hoyem and Martha A. Jacob and Christopher Ross} } @article {5603, title = {Family Care, Nursing Home Transitions, and States{\textquoteright} Long-Term Care Policies}, year = {2004}, note = {RDA}, institution = {University of Illinois-Chicago}, keywords = {Healthcare}, author = {Muramatsu, Naoko and Richard T. Campbell and Ruby L Hoyem and Martha A. Jacob and Chris Ross and yin, Hongjun} }