Rebalance Without the Balance: A Research Note on the Availability of Community-Based Services in Areas Where Nursing Homes Have Closed

Tyler, Denise; Fennell, Mary L.

doi:10.1177/0164027515622244

Cited by 16 publications

(21 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Problems in the rural health care and LTSS systems are longstanding and well-known to rural stakeholders. In addition to the familiar challenge of sustaining services in rural, low-volume settings (Medicare Payment Advisory Commission, 2008), notable weaknesses in the rural LTSS infrastructure include shortages of primary care professionals (Doescher, Skillman, & Rosenblatt, 2009), difficulties in recruiting and retaining direct service workers (D. K. Brown, Lash, Wright, & Tomisek, 2011), and a scarcity of HCBS provider organizations (Coburn et al, 2006;Hawes, Sherman, Hutchison, Phillips, & Holan, 2005;Hong, 2006;Melnick, Ferrer, Shanks-McElroy, & Dunay, 2013;Tyler & Fennell, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the availability of HCBS (Coburn et al, 2006) and residential care (Lenardson et al, 2014) have been thought to be more limited, though much of the data on these questions are dated. However, in a recent national study of services in markets where nursing homes have closed, Tyler and Fennell (2017) found rural areas lacked community-based services in comparison with urban markets. Moreover, family caregiving may be growing less available in rural areas, as more working-age adults leave rural communities for job opportunities elsewhere (Nash, Tramuto, & Coughlin, 2017).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Workforce shortages and other challenges are likely to put rural communities at a considerable disadvantage as they work to meet the heightened demand for health-care and LTSS services that will accompany the upcoming growth in their elderly populations. Many have questioned the capacity and appropriateness of rural LTSS systems to address the needs and preferences of rural seniors (Tyler & Fennell, 2017). For over 30 years, federal and state policies have promoted a “rebalancing” of the LTSS system away from nursing home to assisted living 1 and home and community-based service (HCBS) options designed to allow seniors to age in place at home or in the community (Saucier, Burwell, & Gerst, 2005; Sebelius & Anderson, 2011; Brown et al, 2007; Wysocki et al, 2015).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas

et al. 2019

View full text Add to dashboard Cite

State and federal policies have shifted long-term services and support (LTSS) priorities from nursing home care to home and community-based services (HCBS). It is not clear whether the rural LTSS system reflects this system transformation. Using the Medicare Current Beneficiary Survey, we examined nursing home use among rural and urban Medicare beneficiaries aged 65 and older. Study findings indicate that even after controlling for known predictors of nursing home use, rural Medicare beneficiaries exhibited greater odds of nursing home residence and that the higher odds of rural nursing home residence are, in part, associated with higher rural nursing home bed supplies. A complex interplay of policy, LTSS infrastructure, and social, cultural, and other factors may be influencing the observed differences. Federal and state efforts to build rural HCBS capacity may be necessary to mitigate stubbornly persistent rural-urban differences in the patterns of institutional and community-based LTSS use.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Our findings suggest that rebalancing efforts may have unintended consequences. Groups may not benefit equally 3,16 from policy interventions such as BIP if there are barriers to the existence or growth of HCBS. Further, policies emphasizing HCBS over institutional LTSS may have unintended negative effects on rural persons by limiting the institutional LTSS safety net.…”

Section: Conclusion and Relevancementioning

confidence: 99%

“…3 Additionally, recent analyses found that in rural areas, nursing home closures occurred despite limited availability of HCBS services in their stead. 16 Medical care access disparities have been attributed to structural factors, such as limited transportation infrastructure, distances separating providers and patients, and provider shortages. 15,[17][18][19] In tandem with these medical care barriers, rural populations tend to be older, poorer, and fare worse on numerous health indicators compared to urban residents.…”

Section: Introductionmentioning

confidence: 99%

Rural-Urban Disparities in Access to Home- and Community-Based Services and Supports: Stakeholder Perspectives From 14 States

Siconolfi

Shih

Friedman

et al. 2019

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

Objectives: Trends over time in the United States show success in rebalancing long-term services and supports (LTSS) towards increased home and community-based services (HCBS) relative to institutionalized care. However, the diffusion and utilization of HCBS may be inequitable across rural and urban residents. We sought to identify potential disparities in rural HCBS access and utilization, and to elucidate factors associated with these disparities. Design:We used qualitative interviews with key informants to explore and identify potential disparities and their associated supply-side factors. Setting and participants:We interviewed three groups of healthcare stakeholders (Medicaid administrators, service agency managers and staff, and patient advocates) from 14 states (n = 40).Measures: Interviews were conducted using a semi-structured interview guide, and data were thematically coded using a standardized codebook.Results: Stakeholders identified supply-side factors inhibiting rural HCBS access, including limited availability of LTSS providers, inadequate transportation services, telecommunications barriers, threats to business viability, and challenges to caregiving workforce recruitment and retention. Stakeholders perceived that rural persons have a greater reliance on informal caregiving supports, either as a cultural preference or as compensation for the dearth of HCBS.

show abstract

Changes in Nursing Home Use Following Medicaid-Supported Expanded Access to Home- and Community-Based Services for Older Adults With Dementia

et al. 2023

View full text Add to dashboard Cite

ImportanceNew York State’s Medicaid managed long-term care (MLTC) program expanded access to home- and community-based services, providing an alternative to nursing home care for people with dementia. Between 2012 and 2015, the state implemented mandatory MLTC for dual Medicare and Medicaid enrollees requiring more than 120 days of community-based long-term care.ObjectiveTo evaluate changes in nursing home use among older adults with dementia following MLTC implementation.Design, Setting, and ParticipantsThis cohort study used longitudinal data from January 1, 2011, to December 31, 2019, from the Minimum Data Set and Medicare administrative data. The study sample included New York State Medicare beneficiaries 65 years and older with dementia. New York City residents were excluded due to insufficient pre–study period data. Data were analyzed from January 1, 2011, to December 31, 2019.ExposureMandatory MLTC enrollment.Main Outcomes and MeasuresLongitudinal models were used to evaluate changes in annual days of nursing home use following the staggered implementation of MLTC across 13 regions of the state. Two models were estimated: (1) a logistic regression model for any nursing home use in a given year and (2) a linear regression model of total nursing home days, conditional on any nursing home use. Models included annual event-time indicators specified as years until or since MLTC implementation. To capture MLTC effects for dual enrollees relative to non–dual Medicare enrollees, models included interaction terms for dual enrollment and event-time indicators.ResultsThis sample included 463 947 Medicare beneficiaries with dementia who lived in New York State between 2011 and 2019 (50.2% younger than 85 years; 64.4% women). Implementation of MLTC was associated with lower odds of nursing home use among dual enrollees, ranging from 8% lower odds 2 years post implementation (adjusted odds ratio, 0.92 [95% CI, 0.86-0.98]) to 24% lower odds 6 years post implementation (adjusted odds ratio, 0.76 [95% CI, 0.69-0.84]). Compared with a scenario of no MLTC, MLTC implementation was associated with an 8% reduction in annual days of nursing home use between 2013 and 2019 (mean, −5.6 [95% CI, −6.1 to −5.1] days per year).Conclusions and RelevanceThe findings of this cohort study suggest that implementation of mandatory MLTC in New York State was associated with less nursing home use among dual enrollees with dementia and that MLTC may help prevent or delay nursing home placement among older adults with dementia.

show abstract

Rebalance Without the Balance: A Research Note on the Availability of Community-Based Services in Areas Where Nursing Homes Have Closed

Cited by 16 publications

References 20 publications

Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas

Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas

Rural-Urban Disparities in Access to Home- and Community-Based Services and Supports: Stakeholder Perspectives From 14 States

Changes in Nursing Home Use Following Medicaid-Supported Expanded Access to Home- and Community-Based Services for Older Adults With Dementia

Contact Info

Product

Resources

About