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. 2012 Aug 6;2(3):mmrr.002.03.a03.
doi: 10.5600/mmrr.002.03.a03. eCollection 2012.

Volume of home- and community-based services and time to nursing-home placement

Laura P Sands  1 , Huiping Xu  2 , Joseph Thomas 3rd  3 , Sudeshna Paul  4 , Bruce A Craig  1 , Marc Rosenman  2 , Caroline C Doebbeling  5 , Michael Weiner  6
Affiliations

Volume of home- and community-based services and time to nursing-home placement

Laura P Sands et al. Medicare Medicaid Res Rev. .

Abstract

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: Aged and Disabled; Home and Community Based Care; Medicaid; Nursing Home; Waivers.

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