Online Program

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

Monday, November 4, 2013

Kali Thomas, PhD, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
Vincent Mor, PhD, Center for Gerontology & Health Care Research, Brown University, Providence, RI
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.

Learning Areas:

Administer health education strategies, interventions and programs
Advocacy for health and health education
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe the relationship between states' investments in Older Americans Act in-home services and the relationship to the prevalence of residents in nursing homes who could perhaps be cared for in the community. Identify the potential cost savings to the states Medicaid programs by increasing the proportion of older adults who receive Older Americans Act in-home services.

Keyword(s): Long-Term Care, Community-Based Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting research in long-term care for over 7 years. Among my scientific interests have been the quality of care in nursing homes and utilization of home and community based services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.