Does Home Care Prevent or Defer Nursing Home Use?

Are chronically disabled elders residing in the community who use home and community-based services (HCBS) less likely to end up in a nursing home? The 2004 National Long-Term Care Survey (NLTCS), a nationally representative sample of Americans aged 65 and older, was linked to follow-up years of Medicare/Medicaid claims and other administrative data. Controlling for disability severity and other factors known to be associated with increased likelihood of long-stay (non-Medicare covered) nursing home care, multivariate regression analyses found a statistically significant, but modest association between use of paid HCBS within two years. The association was statistically significant regardless of the source of payment for HCBS, but was stronger for Medicaid-financed HCBS compared to HCBS financed by other sources (mostly private pay). This is one of only a few scientifically rigorous research studies to have found a statistically significant association between use of paid HCBS (and, specifically, Medicaid-financed HCBS) and reduced use of long-stay nursing home care. However, the amount of nursing home use reduced was not enough to produce savings sufficient to offset HCBS costs.