Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter?

J Gerontol B Psychol Sci Soc Sci. 2007 May;62(3):S169-78. doi: 10.1093/geronb/62.3.s169.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Caregivers / economics
  • Cohort Studies
  • Cost Savings / statistics & numerical data
  • Cost-Benefit Analysis
  • Female
  • Financing, Government / economics*
  • Health Expenditures
  • Home Care Services / economics*
  • Homes for the Aged / economics*
  • Humans
  • Insurance Coverage / economics
  • Long-Term Care / economics*
  • Male
  • Medicaid / economics
  • Medicare / economics
  • Nursing Homes / economics*
  • Patient Admission / economics*
  • Patient Readmission / economics
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • State Health Plans / economics
  • United States