Comparing States' Medicaid Nursing Facilities and Home and Community-Based Services Long-Term Care Programs: Quality and Fit with Inclination, Capacity, and Need

• Published in: Journal of aging & social policy Vol. 21; no. 1; pp. 52 - 74
• Main Authors: Lockhart, Charles, Giles-Sims, Jean, Klopfenstein, Kristin
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Group 01-01-2009; Taylor & Francis LLC
• Subjects: Aged; Aging; Capacity; Clinics; Community health care; Cross-Sectional Studies; Health technology assessment; home and community-based services; Home Care Services - organization & administration; Homes for the Aged - organization & administration; Humans; Long Term Care; Long-Term Care - organization & administration; Medicaid; Medicaid program; Medical service; Nursing; nursing facility care; Nursing homes; Nursing Homes - organization & administration; Quality of Health Care; Quality of Life; Regression analysis; Social Policy; Social Programs; Staff Development; state long-term care policy; Treatment Programs; United States; United States
• ISSN: 0895-9420; 1545-0821
• DOI: 10.1080/08959420802539381

States employ home and community-based services (HCBS) increasingly in Medicaid support of long-term care and rely less on nursing facilities. We examine how states' nursing facilities and HCBS programs compare and whether states' long-term care responses match their ideological inclination toward, material capacity for supporting, and their citizens' need for these public social programs. We use cross-sectional panel data on structural, process, and outcome quality for nursing facilities and HCBS congregate residential programs. We rank states, correlate these measures, and use regression to link inclination, capacity, and need to quality. We find that states' nursing facility and HCBS program quality are not closely related and that state HCBS congregate residential program quality is independent of inclination, capacity, and need. This latter result underscores a need for uniform HCBS standards and better data on quality.