Differences in Living Arrangements Among Older Adults Transitioning Into the Community: Examining the Impact of Race and Choice

J Appl Gerontol. 2019 Apr;38(4):454-478. doi: 10.1177/0733464816687496. Epub 2017 Jan 8.


The federal Money Follows the Person Rebalancing Demonstration program allows nursing home residents to use Medicaid funds for home and community-based services rather than institutional care. Race, choice in housing, and challenges faced prior to transitioning may impact living arrangements following a discharge into the community. This study examines the influence of these factors on living arrangements for 659 program participants age 65 or older. Unmarried Blacks and people with financial or legal challenges are less likely to live with a live-in caregiver or in supervised housing compared with unmarried Whites. Race did not determine living arrangements among married participants, but housing transition challenges did. Findings inform policies targeting nursing home rebalancing efforts by highlighting racial diversity in living arrangements and emphasizing the need for affordable, accessible housing options for older adults of any race seeking to live in the community rather than remain in an institutional setting.

Keywords: LTSS; housing; living arrangements; race.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Black or African American / statistics & numerical data*
  • Female
  • Health Services Needs and Demand / statistics & numerical data*
  • Health Services for the Aged / organization & administration*
  • Homes for the Aged
  • Housing for the Elderly*
  • Humans
  • Longitudinal Studies
  • Male
  • Medicaid / economics
  • Multivariate Analysis
  • Nursing Homes
  • Patient Discharge*
  • Residence Characteristics*
  • United States
  • White People / statistics & numerical data*