HCBS Service Spending and Nursing Home Placement for Patients With Alzheimer’s Disease and Related Dementias: Does Race Matter?

Abstract

Objectives: We examined the extent to which home and community-based services (HCBS) spending affected the likelihood of nursing home (NH) placement among black and white HCBS users with Alzheimer’s disease and related dementias (ADRD). Methods: The study population included new HCBS users with ADRD between 2010 and 2013 ( N = 1,046,200). Results: We found that a one hundred dollar increase in monthly HCBS spending was associated with a 0.3 percentage points decrease in the NH placement rate among Whites, but a 0.3 percentage points increase in the NH placement rate among Blacks. The overall NH placement rate was 68.2% and 56.7% for Whites and Blacks, respectively. Discussion: A higher HCBS spending was associated with a decreased likelihood of NH placements for Whites but not for Blacks. It is important to understand how states’ HCBS expansion efforts influence Blacks and Whites with ADRD so that resources can be tailored to communities with different race-mix.

The critical role of Medicaid home‐ and community‐based services in meeting the needs of older adults in the United States

“…The variation in eligibility criteria and availability of HCBS across states has not only led to a lack of data allowing causal evaluations, but the complexity of HCBS may result in and/or exacerbate barriers to accessing services. [16][17][18][19][20] Medicaid beneficiaries face significant administrative burden and complexity that include, but are not limited to, costs to patients, eligibility requirements, availability of local service providers, and time delays. 21 These barriers contribute to and exacerbate existing disparities in access to HCBS.…”

State home and community‐based services expenditures and unmet care needs in the United States: Has everyone benefitted equally?

“…12 Higher HCBS expenditures may help older people avoid or delay any nursing home care, 13 and as a result, the expansion of HCBS spending has been linked to a population-level decline in the use of long-term care based in institutionalized settings. 9 However, the association between increased state HCBS expenditures and reduction in nursing home placement is observed for white Medicaid beneficiaries, but not for their Black counterparts, 14 suggesting that the impacts of efforts to enable aging in place may not have had an equitable impact.…”

Post‐acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status

“…Persons with dementia may be particularly at risk of experiencing preventable or unnecessary care transitions, 13 which may be further exacerbated among racial and ethnic minorities 8 . Studies have shown that ADRD is an important contributor to disparities among older adults, including impaired access to health services and poorer outcomes 14–16 . To date, however, no study has examined how PAC transitions may differentially affect minority older adults with ADRD, and the extent to which socio‐economic status, that is, dual Medicare‐Medicaid eligibility, may attenuate or exacerbate disparities in PAC outcomes.…”

“…8 Studies have shown that ADRD is an important contributor to disparities among older adults, including impaired access to health services and poorer outcomes. [14][15][16] To date, however, no study has examined how PAC transitions may differentially affect minority older adults with ADRD, and the extent to which socio-economic status, that is, dual Medicare-Medicaid eligibility, may attenuate or exacerbate disparities in PAC outcomes. This is particularly important for older adults with dementia who are likely to experience cognitive and physical deconditioning during a hospital stay and subsequent PAC transitions to unfamiliar environments.…”