title: Predictors of low-care prevalence in Florida nursing homes: the role of Medicaid waiver programs.
abstract: OBJECTIVE
  To examine the relationship between county-level Medicaid home- and community-based service (HCBS) waiver expenditures and the prevalence of low-care residents in Florida nursing homes (NHs).
  
  
  METHODS
  The present study used a cross-sectional design. We combined two data sources: NH facility-level data (including characteristics of the facility and its residents) and county-level market characteristics (including HCBS waiver expenditures) for 653 Florida NHs in 2007. Low-care was defined as residents who require no physical assistance in any of the 4 late-loss activities of daily living (bed mobility, toileting, transferring, and eating). We estimated a 2-level hierarchical linear model (HLM) to examine the relationship between Medicaid HCBS waiver expenditures and the prevalence of low-care residents while accounting for resident assessment, facility-, and county-level covariates.
  
  
  RESULTS
  All Florida counties offered 2 statewide waivers, and 33 counties offered one or more of the 4 regional Medicaid HCBS waivers in 2007. Per-month beneficiary expenditures ranged from $755 to $1,778. The average Florida NH had 120 beds, and 8.0% of its residents were classified as low-care. Results from the HLM model showed that a $10,000 increase in per-enrollee HCBS waiver expenditures was associated with a 3.5 percentage point reduction in low-care resident prevalence (p = .03).
  
  
  CONCLUSIONS
  The findings suggest that Medicaid HCBS waiver programs may reduce the prevalence of low-care residents in NHs. Future studies should evaluate whether Medicaid HCBS waiver programs are effective in promoting community-living among low-care residents and mitigating the growth in long-term care expenditures.
authors.affiliation: School of Aging Studies and the Florida Policy Exchange Center on Aging, University of South Florida, Tampa, FL 33620, USA. ehahn@usf.edu
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hahn
authors.forename: Kali S
authors.initials: KS
authors.lastname: Thomas
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hyer
authors.forename: Ross
authors.initials: R
authors.lastname: Andel
authors.forename: Hongdao
authors.initials: H
authors.lastname: Meng
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000191:economics / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004608:Eligibility Determination; D005260:Female; D005431:Florida; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000145:classification / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D013221:State Health Plans / Q000191:economics / Q000706:statistics & numerical data; D014481:United States