+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture



The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture



Osteoporosis International 27(3): 953-961



This study measures the effect of spending policies for long-term care services on the risk of becoming a long-stay nursing home resident after a hip fracture. Relative spending on community-based services may reduce the risk of long-term nursing home residence. Policies favoring alternative sources of care may provide opportunities for older adults to remain community-bound. This study aims to understand how long-term care policies affect outcomes by investigating the effect of state-level spending for home- and community-based services (HCBSs) on the likelihood of an individual's nursing home placement following hip fracture. This study uses data from the 5% sample of Medicare beneficiaries from 2005 to 2010 to identify incident hip fractures among dual-eligibility, community-dwelling adults aged at least 65 years. A multilevel generalized estimating equation (GEE) model estimated the association between an individual's risk of nursing home residence within 1 year and the percent of states' Medicaid long-term support service (LTSS) budget allocated to HCBS. Other covariates included expenditures for Title III services and individual demographic and health status characteristics. States vary considerably in HCBS spending, ranging from 17.7 to 83.8% of the Medicaid LTSS budget in 2009. Hip fractures were observed from claims among 7778 beneficiaries; 34% were admitted to a nursing home and 25% died within 1 year. HCBS spending was associated with a decreased risk of nursing home residence by 0.17 percentage points (p 0.056). Consistent with other studies, our findings suggest that state policies favoring an emphasis on HCBS may reduce nursing home residence among low-income older adults with hip fracture who are at high risk for institutionalization.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 059064334

Download citation: RISBibTeXText

PMID: 26400010

DOI: 10.1007/s00198-015-3327-3


Related references

Relations among home- and community-based services investment and nursing home rates of use for working-age and older adults: a state-level analysis. American Journal of Public Health 101(9): 1735-1741, 2011

A state-level examination of the association between home and community-based services and rates of nursing home residency with special attention to nutrition programs. Journal of Nutrition in Gerontology and Geriatrics 31(4): 404-424, 2012

Medicaid program; state plan home and community-based services, 5-year period for waivers, provider payment reassignment, and home and community-based setting requirements for Community First Choice and home and community-based services (HCBS) waivers. Final rule. Federal Register 79(11): 2947-3039, 2014

Home-and community-based alternatives to nursing homes: services and costs to maintain nursing home eligible individuals at home. Journal of Aging and Health 15(2): 353-370, 2003

Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter?. Journals of Gerontology. Series B Psychological Sciences and Social Sciences 62(3): S169-S178, 2007

State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis. Journal of Health and Social Behavior 43(1): 107-124, 2002

Volume of home- and community-based services and time to nursing-home placement. Medicare and Medicaid Research Review 2(3):, 2012

Predicting nursing home placement among home- and community-based services program participants. American Journal of Managed Care 20(12): E535-E536, 2014

New directions in home & community-based services at the state level. Caring 20(8): 12-14, 2001

Depression in elderly women resident in a long-stay nursing home. Dementia and Neuropsychologia 9(1): 76-80, 2015

Local Medicaid home- and community-based services spending and nursing home admissions of younger adults. American Journal of Public Health 104(11): E15-E17, 2014

Penny wise, pound wise: a comparison of Medicaid expenditures for home and community-based services versus nursing facility care for older adults. Home Health Care Services Quarterly 23(4): 15-28, 2004

Government expenditures at the end of life for short- and long-stay nursing home residents: differences by hospice enrollment status. Journal of the American Geriatrics Society 52(8): 1284-1292, 2004

Expenditures on services for persons with acquired immunodeficiency syndrome under a Medicaid home and community-based waiver program. Are selection effects important?. Medical Care 35(5): 425-439, 1997

VA staff perceptions of the role of the extended care referral process in home and community-based services versus nursing home use posthospital discharge. Home Health Care Services Quarterly 36(2): 63-80, 2017