Relationship between older americans act in-home services and low-care residents in nursing homes

The purpose of this study is to examine the relationship between the proportion of older adults in a state who receive these in-home services and the proportion of residents in nursing homes whose needs could better be served in the community. We combined two data sources: State Program Reports (utilization data for each OAA service at the state level) and NH facility–level data (including characteristics of the facility, the market, and residents) for US NHs from 2005-2009. Using a two-way fixed effects model, we examined the relationship between the proportion of older adults receiving in-home supportive services in the state and the percentage of residents in nursing homes classified as having low-care needs, controlling for Medicaid HCBS spending, facility characteristics, market characteristics, and secular trends. Results suggest that for every additional 1% of the population age 65+ that receives personal care services in the home is associated with a 0.8% decrease in the proportion of low care residents in nursing homes. It is important to note that this is above the proportion of Medicaid spending that goes toward HCBS, which also includes personal care services. Despite efforts to rebalance long-term care, there are still many NH residents who have the functional capacity to live in a less restrictive environment. This is among the first studies to suggest that states that have invested in their in-home supportive services, particularly personal care services, provided through the OAA have proportionally fewer of these people.