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Journal of Nutrition in Gerontology and Geriatrics Volume 31, 2012 - Issue 4
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ORIGINAL RESEARCH

A State-Level Examination of the Association Between Home and Community-Based Services and Rates of Nursing Home Residency with Special Attention to Nutrition Programs

David R. Buys Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama, USACorrespondence[email protected]
,
Casey Borch Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Meredith Kilgore Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA; Lister Hill Center for Health Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Claire A. Zizza Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama, USA
&
Julie L. Locher Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA; Lister Hill Center for Health Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
Pages 404-424 | Published online: 16 Nov 2012
 
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Abstract

Federal food and nutrition programs implemented by the Administration on Aging and funded by the Older Americans Act (OAA) seek to enable older adults to remain in their homes and communities through a comprehensive, coordinated, and cost-effective array of services. We hypothesized that expenditures devoted to nutrition programs for home and community-based nutrition services were inversely related to changes in state-level rates of institutionalization for older adults from one year to the next, such that states that spend more money per capita on community-based nutrition programs would have smaller increases or greater decreases in rates of institutionalization, controlling for expenditures on other home and community-based services. We found, however, that there was not an effect of OAA Nutrition Services on the change in rates of nursing home residency. We noted, though, that states that direct a greater proportion of their long-term care expenditures to home and community-based services appear to have more reduction in their rates of nursing home residency. Further longitudinal work at the state and individual levels is warranted.

Notes

Note. Instit., institutionalization.

a Rates are per 1000 individuals.

*Change in Rate of Inst. = Rate of institutionalized persons 65 (2008) – Rate of institutionalized persons 65 (2007).

**Rate of Change in Inst. = Change in Rate of Inst./Rate of institutionalized persons 65 (2007).

Note. CM, congregate meals; HCBS, home and community-based services; HDM, home-delivered meals; LTC, long-term care.

a Gross state product is in millions of dollars.

b Per capita expenditures are in dollars per non-institutionalized older adult.

Note. LTC, long-term care; HCBS, home and community-based services; NIOA, noninstitutionalized older adults. Standard error is reported in parenthesis under the slope coefficient.

*P < .05; **P < .01; ***P < .0 01 (two-tailed tests).

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