US states that have invested in community-based service networks, particularly home-delivered meals, have proportionally fewer nursing home (NH) residents with low-care needs, report researchers.
Indeed, the team found that increased spending on Older Americans Act (OAA) and Medicaid home and community-based services (HCBS) programs was associated with a reduced overall prevalence of functionally capable NH residents.
"As the United States prepares for an aging population and the demand for health and social services necessary to assist older adults to live independently in the community increases, ensuring access to HCBS will likely continue to be an issue for policy makers," say the authors in Health Services Research.
Kali Thomas and Vincent Mor (Brown University in Providence, Rhode Island, USA) used data from 2000 to 2009 for 16,030 NH institutions to analyze whether US states that invest more money into OAA programs have fewer NH residents aged 65 years and over with low-care needs.
The pair defined residents as having low-care needs if they required no physical assistance in any of the four late-loss activities of daily living: bed mobility, toileting, transferring, and eating. The OAA-based programs included for analysis were Personal Care, Homemaker, Chore, Home-Delivered Meals, and Adult Day Care/Health Case Management.
Thomas and Mor observed that the percentage of Medicaid dollars spent per state on HCBS programs increased during the study period, from a mean of 18% to 32%, and this corresponded with a decrease in the percentage of NH residents classified as low care, from 18% to 13%.
Furthermore, multivariate analysis revealed that increased spending on home-delivered meals was associated with fewer NH residents with low-care needs, indicated by a 1% decrease in low-care NH population for every additional US$ 25 (€ 19) spent on the service.
The authors illustrate this finding using the states of Washington and Wyoming. These states spent a respective mean $ 8.10 (€ 6.21) and $ 82.46 (€ 63.17) per capita on this service, and had a low-care NH population of 16.8% and 13.8%, respectively.
"The home-delivered meals program is designed to address problems of food insecurity, promote socialization, and promote the health and well-being of older persons through nutrition and nutrition-related services," Thomas and Mor conclude.
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