The relationship between older Americans Act Title III state expenditures and prevalence of low-care nursing home residents

Health Serv Res. 2013 Jun;48(3):1215-26. doi: 10.1111/1475-6773.12015. Epub 2012 Dec 3.


Objective: To test the relationship between older Americans Act (OAA) program expenditures and the prevalence of low-care residents in nursing homes (NHs). DATA SOURCES AND COLLECTION: Two secondary data sources: State Program Reports (state expenditure data) and NH facility-level data downloaded from for 16,030 US NHs (2000-2009).

Study design: Using a two-way fixed effects model, we examined the relationship between state spending on OAA services and the percentage of low-care residents in NHs, controlling for facility characteristics, market characteristics, and secular trends.

Principal findings: Results indicate that increased spending on home-delivered meals was associated with fewer residents in NHs with low-care needs.

Conclusions: States that have invested in their community-based service networks, particularly home-delivered meal programs, have proportionally fewer low-care NH residents.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aging
  • Health Expenditures / statistics & numerical data*
  • Homes for the Aged / economics*
  • Homes for the Aged / statistics & numerical data*
  • Humans
  • Medicaid / statistics & numerical data
  • Needs Assessment
  • Nursing Homes / economics*
  • Nursing Homes / statistics & numerical data*
  • Prevalence
  • State Government*
  • United States