@article {11056, title = {Effects of long-term care setting on spousal health outcomes.}, journal = {Health Serv Res}, volume = {54}, year = {2019}, month = {2019 02}, pages = {158-166}, abstract = {

OBJECTIVE: To provide empirical evidence on the effects of home and community-based services (HCBS) (vs nursing home) use on spousal health.

DATA SOURCES: Merged data from the 1996 to 2012 Health and Retirement Study (HRS) and the Area Health Resource File (AHRF).

STUDY DESIGN: We assess the impact of HCBS use on spousal health. We use an instrumental variable (IV) approach to account for the potential endogeneity of the choice of care setting and reverse causality. Our instrument is the supply of skilled nursing home beds per 1000 people older than 65~years.

DATA EXTRACTION METHODS: Our sample includes spouses of HCBS or nursing home users, resulting in 8608 observations.

PRINCIPAL FINDINGS: We find that HCBS use leads to harmful effects on spousal physical health, which may be caused by increased informal care responsibilities. We also find improved spousal mental health, especially in depression symptoms, which may be caused by increased satisfaction.

CONCLUSIONS: We find evidence of both beneficial (mental health) and harmful (physical health) consequences for spouses of individuals receiving LTC at home relative to in an institution. Our results are important in estimating the potential cost and effectiveness of HCBS expansion.

}, keywords = {Adaptation, Psychological, Aged, Caregivers, Community Health Services, Female, Humans, Long-term Care, Male, Patient Preference, social isolation, Spouses}, issn = {1475-6773}, doi = {10.1111/1475-6773.13053}, author = {Dong, Jing and Pollack, Harold and R. Tamara Konetzka} } @article {8809, title = {Home and community-based service and other senior service use: Prevalence and characteristics in a national sample.}, journal = {Home Health Care Serv Q}, volume = {36}, year = {2017}, month = {2017 Jan-Mar}, pages = {16-28}, abstract = {

We report on the use of home and community-based services (HCBS) and other senior services and factors affecting utilization of both among Americans over age 60 in the Health and Retirement Study (HRS). Those using HCBS were more likely to be older, single, Black, lower income, receiving Medicaid, and in worse health. Past use of less traditional senior services, such as exercise classes and help with tax preparation, were found to be associated with current use of HCBS. These findings suggest use of less traditional senior services may serve as a "gateway" to HCBS that can help keep older adults living in the community.

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Female, Home Care Services, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Prevalence, Senior Centers, United States}, issn = {1545-0856}, doi = {10.1080/01621424.2016.1268552}, url = {https://www.tandfonline.com/doi/full/10.1080/01621424.2016.1268552}, author = {Amanda Sonnega and Kristen N Robinson and Helen G Levy} } @article {7477, title = {Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference?}, journal = {Soc Sci Med}, volume = {70}, year = {2010}, month = {2010 Apr}, pages = {1050-8}, publisher = {70}, abstract = {

This study examines how acute and chronic stresses associated with functional declines in seniors and their spouses are moderated by their informal and formal support contexts. In the United States, states vary greatly in their support for home and community-based services (HCBS) for seniors with disabilities. This state-to-state variation allowed us to examine mental health effects of living in a society supportive of HCBS for the oldest old, who are at high risk for low or declining functions in daily activities and cognitive abilities. Using a ten-year panel study of a nationally representative sample of the oldest old (>or=70 years old) covering the period 1993-2002, we conducted mixed-effects logistic regression analysis to incorporate time-varying characteristics of persons and states. As expected, low and declining functions in daily living and cognition constituted significant stressors among seniors and their spouse. Results demonstrated the important role of informal support available from non-spouse family/friends in lowering depression. Living in a state supportive of HCBS was associated with lower depression among seniors experiencing consistently low levels of function or recent functional declines, especially among those without informal support. Our findings were consistent with moderating or buffering models of formal support, suggesting that state HCBS support is effective mainly under conditions of high levels of stressors. Political will is needed to prepare US society to collectively support community-based long-term needs, given the difficulty of preparing ourselves fully for common, but often unexpected, functional declines in later life.

}, keywords = {Activities of Daily Living, Aged, Cognition, Community Health Services, depression, Disabled Persons, Female, Home Care Services, Humans, Logistic Models, Male, Mental Health, Multilevel Analysis, Risk Factors, Social Support, Spouses, State Government, Stress, Psychological, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2009.12.005}, author = {Muramatsu, Naoko and yin, Hongjun and Hedeker, Donald} } @article {7462, title = {Older adults{\textquoteright} expectations to move: do they predict actual community-based or nursing facility moves within 2 years?}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Oct}, pages = {1029-53}, abstract = {

OBJECTIVE: This study examined the relationship between older adults{\textquoteright} expectations to move and actual residential relocation in the community or to a nursing facility within 2 years.

METHOD: Two waves of data (2000, 2002) from the Health and Retirement Study were used to compare expectations with subsequent moves. Logistic regression techniques were used to analyze the association between decision outcomes and expectations to move, health and functioning, physical environment, informal supports, and formal services.

RESULTS: Findings indicated that expectations to move did predict community-based moves but did not predict moves to nursing facilities. Additional factors had significant effects but did not diminish relationships between expectations and actual moves.

DISCUSSION: Results support the residential decision process as a dynamic one based on the cumulative effect of factors from an ecological model. Findings will inform policy makers and practitioners as they work to support older adults{\textquoteright} preferences to remain living in their homes.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Community Health Services, Decision making, Female, Humans, Logistic Models, Male, Odds Ratio, Residence Characteristics, Skilled Nursing Facilities, Social Support, Statistics as Topic, Time Factors, Transients and Migrants}, issn = {1552-6887}, doi = {10.1177/0898264310368296}, author = {Julie F. Sergeant and David J Ekerdt and Chapin, Rosemary K} } @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 {6792, title = {State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis.}, journal = {J Health Soc Behav}, volume = {43}, year = {2002}, note = {RDA 1996-025}, month = {2002 Mar}, pages = {107-24}, publisher = {43}, abstract = {

Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults{\textquoteright} strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals{\textquoteright} demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Female, Financing, Government, Frail Elderly, Health Care Surveys, Health Expenditures, Home Care Services, Humans, Logistic Models, Male, State Government}, issn = {0022-1465}, doi = {10.2307/3090248}, author = {Muramatsu, Naoko and Richard T. Campbell} }