TY - JOUR T1 - Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Muramatsu, Naoko A1 - yin, Hongjun A1 - Richard T. Campbell A1 - Ruby L Hoyem A1 - Martha A. Jacob A1 - Christopher Ross KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cohort Studies KW - Cost Savings KW - Cost-Benefit Analysis KW - Female KW - Financing, Government KW - Health Expenditures KW - Home Care Services KW - Homes for the Aged KW - Humans KW - Insurance Coverage KW - Long-term Care KW - Male KW - Medicaid KW - Medicare KW - Nursing homes KW - Patient Admission KW - Patient Readmission KW - Risk Assessment KW - Risk Factors KW - State Health Plans KW - United States AB -

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' 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.

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507592?dopt=Abstract U4 - Home Care Services/Nursing Homes/Health Policy/Elderly ER -