Older adults with difficulty living independently are more likely to remain in their homes when states devote a larger share of long-term care spending to home- and community-based services, according to a new study.

Researchers examined whether state investments in home- and community-based services — known as HCBS — were associated with changes in where older adults lived, including whether they moved, lived with adult children or entered group housing settings.

The study, published by JAMA Health Forum, analyzed data from 7.35 million older adults using U.S. Census Bureau American Community Survey records from 2009 through 2021.

The findings suggest that expanding access to in-home assistance may help older adults avoid unwanted moves and maintain greater independence.

“Most older adults prefer to remain in their own homes and communities,” researchers wrote. “[They want to] remain autonomous, maintain community-based social ties, and avoid the negative stigma associated with institutional living, (ie, aging in place).

“However, changes in cognitive and functional status during the aging process are associated with an increased risk of dementia and relocating and entering institutional care or living with adult children. These risks may be mitigated through high-quality long-term care.”

Greater HCBS investment tied to fewer residential changes

Among older adults with independent living difficulties, a 20-percentage-point increase in a state’s share of long-term services and support spending directed toward HCBS was associated with a 2.6-percentage-point lower likelihood of living in group quarters, such as institutional or other congregate settings.

The same increase was linked to an 0.8-percentage-point decrease in living with adult children, a 1-percentage-point increase in remaining in the same residence, and lower rates of both in-state and out-of-state moves.

Researchers said the results indicate that stronger HCBS systems may reduce the need for older adults with functional limitations to relocate for care or depend as heavily on family members for housing support.

The study also found some evidence that expanded HCBS availability may increase Medicaid enrollment among some older adults, but researchers described the effect as modest and inconsistent across analyses.

While public programs play a major role in supporting aging in place, many older adults and families also rely on personal resources to pay for modifications and services that allow someone to remain safely at home.

For homeowners with significant equity, reverse mortgages can be one option to help fund aging-in-place expenses, including home accessibility improvements, in-home care costs and other long-term support needs.

Policy focus shifts toward community-based care

The researchers said the findings support continued investment in HCBS programs, workforce development and broader access to noninstitutional care.

The study’s authors noted that the U.S. population is aging rapidly, with older adults expected to make up a growing share of the population in coming decades.

As demand for long-term care rises, policymakers face increasing pressure to expand options that allow people to receive assistance outside nursing homes and other institutional settings.

The researchers concluded that HCBS investments may provide benefits beyond direct services by helping older adults maintain residential stability while reducing disruptions for families and caregivers.

This article was written by Jonathan Delozier and generated with the assistance of HousingWire Automation. It was reviewed by a HousingWire editor before publication.

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