Volume of Home- and Community-Based Services and Time to Nursing-Home Placement

Laura P. Sands,¹ Huiping Xu,² Joseph Thomas III,1, ³ Sudeshna Paul,⁴ Bruce A. Craig,¹ ,Marc Rosenman² ,Caroline C. Doebbeling,⁵ Michael Weiner,^{2, 6, 7, 8}

¹Purdue University
²Indiana University School of Medicine
³Regenstrief Center for Healthcare Engineering
⁴Harvard Medical School
⁵MDwise Hoosier, Indianapolis
⁶Indiana University Center for Health Services and Outcomes Research
⁷Regenstrief Institute, Inc.
⁸Health Services Research and Development Service

Objective: The purpose of this study was to determine whether the volume of Home- and Community-Based Services (HCBS) that target Activities of Daily Living disabilities, such as attendant care, homemaking services, and home-delivered meals, increases recipients’ risk of transitioning from long-term care provided through HCBS to long-term care provided in a nursing home.
Data Sources: Data are from the Indiana Medicaid enrollment, claims, and Insite databases. Insite is the software system that was developed for collecting and reporting data for In-Home Service Programs.
Study Design: Enrollees in Indiana Medicaid’s Aged and Disabled Waiver program were followed forward from time of enrollment to assess the association between the volume of attendant care, homemaking services, home-delivered meals, and related covariates, and the risk for nursing-home placement. An extension of the Cox proportional hazard model was computed to determine the cumulative hazard of nursing-home placement in the presence of death as a competing risk.
Principal Findings: Of the 1354 Medicaid HCBS recipients followed in this study, 17% did not receive any attendant care, homemaking services, or home-delivered meals. Among recipients who survived through 24 months after enrollment, one in five transitioned from HCBS to a nursing-home. Risk for nursing-home placement was significantly lower for each five-hour increment in personal care (HR=0.95, 95% CI=0.92-0.98) and homemaking services (HR=0.87, 95% CI=0.77–0.99).
Conclusions: Future policies and practices that are focused on optimizing long-term care outcomes should consider that a greater volume of HCBS for an individual is associated with reduced risk of nursing-home placement.

Keywords: Medicaid, Home and Community Based Care, Aged and Disabled, Waivers, Nursing Home

doi: http://dx.doi.org/10.5600/mmrr.002.03.a03

Full text HTML for this article is not yet available. Please click the PDF download link to access this article.