title: State commitment to home and community-based services: effects on independent living for older unmarried women.
abstract: This study examines the impact of state variation in commitment to the provision of home and community-based services on the living arrangement outcomes of older unmarried females with functionallimitations. We combine data from the 1990 U.S. Census of Population (PUMS) with state-level information on long-term care home and community- based service expenditures, nursing home bed availability, and Medicaid nursing home costs from a special report that compares state variation in long-term care systems. Using multilevel logistic regression modeling techniques, we find that the risk of institutionalization compared to community living arrangements is reduced as spending for home and community-based services at the state level increases. We discuss these findings in light of policy changes during the 1990s.
authors.affiliation: Gerontology Institute, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA, 02125, USA. jeffrey.burr@umb.edu
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Burr
authors.forename: Jan E
authors.initials: JE
authors.lastname: Mutchler
authors.forename: Jennifer Pilcher
authors.initials: JP
authors.lastname: Warren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006233:Persons with Disabilities; D005260:Female; D005380:Financing, Government / Q000458:organization & administration*; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization; D016015:Logistic Models; D008134:Long-Term Care / Q000191:economics / Q000706:statistics & numerical data; D008484:Medicaid; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012847:Single Person; D012959:Socioeconomic Factors; D013219:State Government