“…The overall LTC cost increases result at least in part from consumers shifting from HCBS to institutional care (D'Souza et al, 2009;Howes, 2010). In addition to providing a lower-cost alternative to institutional care, HCBS waivers and programs have been shown to delay or prevent institutionalization and hospitalization (Chapin, Baca, Macmillan, Rachlin, & Zimmerman, 2009;Pande, Laditka, Laditka, & Davis, 2007;Xu et al, 2010).…”