title: Rebalance Without the Balance: A Research Note on the Availability of Community-Based Services in Areas Where Nursing Homes Have Closed.
abstract: Policies to "rebalance" funding away from nursing homes and toward home and community-based services (HCBS) have encouraged national trends of nursing home closure and an expansion of the HCBS industry. These changes are unfolding without a clear understanding of what services are available at the local level. The purpose of this study was: (1) to describe the current distribution of community-based services (CBS) in areas where nursing homes have closed and (2) to examine differences in availability of CBS using local market and population characteristics as regressors in a multinomial logistic model. We collected data on and geocoded CBS facilities and then used ArcGIS to define a 5-mile radius around all nursing homes that closed between 2006 and 2010 and compared these local market areas. In rural areas, availability of CBS does not appear to compensate for nursing home closures. Policies encouraging HCBS may be outpacing availability of CBS, especially in rural areas.
authors.affiliation: 1 Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA.|2 Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Tyler
authors.affiliation: 1 Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA.|3 Department of Sociology, Brown University, Providence, RI, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Fennell
mesh_terms: D006271:Health Facility Closure / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006699:Home Care Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012424:Rural Population; D012946:Social Welfare / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: community-based services; long-term care; nursing homes; rural access