Key facts
- States dedicating more long-term care spending to home- and community-based services (HCBS) are linked to older adults with independent living difficulties remaining in their homes.
- A study analyzing 7.35 million older adults from 2009-2021 found that a 20-percentage-point increase in HCBS spending share correlated with a 2.6-percentage-point lower likelihood of living in group quarters.
- This increased HCBS investment was also associated with a 0.8-percentage-point decrease in living with adult children and a 1-percentage-point increase in remaining in the same residence.
- The research suggests that robust HCBS systems can reduce the necessity for older adults with functional limitations to relocate for care or depend heavily on family support.
- The study supports continued investment in HCBS programs, workforce development, and broader access to noninstitutional care options.
A new study published in JAMA Health Forum suggests that increased state investment in home- and community-based services (HCBS) is associated with older adults, particularly those facing independent living challenges, remaining in their homes longer. Researchers analyzed data from 7.35 million older adults between 2009 and 2021, finding that a significant increase in the proportion of long-term care spending directed towards HCBS correlated with a lower likelihood of moving to group housing or living with adult children, and a higher likelihood of staying in their current residence.
The study indicates that expanding access to in-home assistance can help older adults maintain autonomy and community ties, avoiding the negative stigma of institutional living. Specifically, a 20-percentage-point rise in a state's HCBS spending share was linked to a 2.6-percentage-point decrease in residing in group quarters and a 1-percentage-point increase in remaining in the same home. These findings suggest that stronger HCBS systems can reduce the need for relocation due to functional limitations.
While the study noted a modest and inconsistent effect on Medicaid enrollment, it highlighted the importance of public programs and personal resources, such as reverse mortgages for homeowners, in supporting aging in place. The researchers advocate for continued investment in HCBS programs, workforce development, and broader access to noninstitutional care, especially as the U.S. population ages and demand for long-term care rises.