State Home-Care Spending Boosts Aging-in-Place Outcomes

States that allocate a larger portion of their long-term care budgets to home- and community-based services (HCBS) see a greater likelihood of older adults with independent living challenges remaining in their homes, according to a study published in JAMA Health Forum. The research analyzed data from 7.35 million older adults using U.S. Census Bureau American Community Survey records between 2009 and 2021.

The findings indicate that enhanced access to in-home assistance can help older adults avoid involuntary residential changes and preserve their autonomy. Researchers noted that most older adults express a preference for aging in place to maintain independence, social connections, and avoid the stigma of institutional living. However, cognitive and functional declines associated with aging can increase the risk of dementia, relocation, and entry into institutional care or living with adult children, risks that can be mitigated by robust long-term care options.

Specifically, the study found that a 20-percentage-point increase in a state's HCBS spending share was associated with a 2.6-percentage-point decrease in older adults with independent living difficulties residing in group quarters, such as nursing homes or assisted living facilities. This investment was also linked to an 0.8-percentage-point reduction in older adults living with adult children and a 1-percentage-point increase in remaining in their current residence. Furthermore, higher HCBS investment correlated with lower rates of both in-state and out-of-state residential moves.

These results suggest that stronger HCBS systems may reduce the necessity for older adults to transition to more restrictive living arrangements. The study's authors emphasize the importance of high-quality long-term care in supporting older adults' desire to age in place and maintain their independence as their health status changes.