The Relationship between Home-Based Services & the Long-Term Care Population

Across the United States, states are looking to identify cost-effective ways to support older adults who wish to live as independently as possible. Funding from the Title III project under the Older Americans Act (OAA) provides assistance, meals, respite, and other in-home and community-based services to community-dwelling older adults. Surveys of OAA program recipients suggest that most credit these services with allowing them to stay in their homes. A study published in Health Services Research explores the effect of these OAA programs at the level of the state, by testing the hypothesis that home- and community-based programs will enable older adults with low care needs to remain in their homes, rather than moving into nursing homes (NHs).

The investigators explored this hypothesis by using state-level data collected between 2000 and 2009 to measure the relationship between OAA program expenditures and the prevalence of “low-care residents” (nursing home residents who don’t require physical assistance with the most basic activities of daily living) within states’ NH populations. The authors cite previous research that suggests that five to 30 percent of NH residents may be able to remain in their homes with increased support. In particular, the authors point to home-delivered meals programs as a way to manage food insecurity and provide social support and informal well-being check-ins.

The data, drawn from State Program Reports from the federal Administration on Aging (OAA expenditures) and from long-term care data collected at Brown University’s Center for Gerontology and Healthcare Research (long-term care usage), suggest that increased expenditures on home- and community-based programs are associated, at the state level, with lower proportions of low-care NH residents.


Thomas KS and Mor V. The relationship between Older Americans Act Title III state expenditures and prevalence of low-care nursing home residents. Health Services Research (2013); 48(3): 1215–1226.

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