Does Home and Community-Based Care Reduce Hospitalizations?
The U.S. Department of Health and Human Services (HHS) estimates that nearly 12 million Americans will require long-term care (LTC) services by 2020, with almost half living with some form of dementia. According to Forbes.com, approximately 50% of all long-term care insurance claims come from policyholders diagnosed with dementia.
Traditionally, Medicaid—the primary federal program financing LTC—has directed most of its funds toward institutional care in nursing facilities. However, these facilities often struggle to meet the needs of an aging population that is living longer and facing more complex health challenges.
In recent years, federal initiatives have encouraged states to expand Home and Community-Based Services (HCBS)programs through Medicaid waivers, allowing more seniors to receive care in their homes or local communities. While this approach may appear beneficial, experts warn that the real-world outcomes are more complicated.
Comparing Home and Community-Based Care to Institutional Care
Evaluating the impact of HCBS versus nursing home care involves more than cost comparisons. It’s essential to consider health outcomes, care quality, and social equity—especially among racial and ethnic minority groups and those living with dementia.
Research shows that people with dementia, regardless of race or income, require higher-intensity care than other groups. Interestingly, hospitalization rates between HCBS recipients and nursing facility residents remain nearly identical, even though nursing home residents tend to be older and sicker.
This raises a key question: if home-based care doesn’t reduce hospitalizations, are we truly improving outcomes—or simply shifting costs?
Why Hospitalization Rates Remain High
A University of Chicago study cited by McKnight’s found that hospitalization rates among HCBS participants remain high because most receive care from untrained or minimally trained caregivers in non-facility settings.
Even with supportive tools and technology, lack of medical training can lead to:
- Delays in recognizing serious health symptoms
- Medication errors or poor medication management
- Missed early interventions that prevent hospital visits
For patients with dementia, these challenges are even more severe. Without secure facilities or 24/7 supervision, individuals are more prone to accidents, infections, or worsening medical conditions that lead to hospitalization.
The Cost Shift: Quality vs. Quantity of Care
Nearly 60% of Medicaid’s long-term care spending now goes toward home and community-based care, reflecting a major shift away from institutional settings. However, despite the investment, studies suggest that HCBS has not significantly reduced hospitalization rates—and may have worsened inequities in care access and outcomes, particularly for minorities and lower-income seniors.
By contrast, skilled nursing facilities provide:
- 24-hour medical oversight
- Trained nursing staff
- Medication and therapy management
- A structured, secure environment for dementia care
These facilities often deliver more consistent outcomes for residents with serious or complex medical conditions.
The Bottom Line: Balancing Independence and Safety
Home and community-based care offers many seniors independence and comfort—but it is not always the best fit for those with advanced medical needs. Policymakers and families alike must weigh the trade-offs between freedom, safety, and quality of care when determining long-term solutions.
Understanding how long-term care choices—including Medicaid and Medicare eligibility—affect both health outcomesand financial stability is critical for older adults and their families.
At Aging in Maine, we help families plan for the future by navigating long-term care options, Medicaid eligibility, and estate planning strategies that protect both health and assets.
📞 Contact us today at (207) 848-5600 to discuss your long-term care planning needs or schedule a consultation online.
