Higher State Spending on Home-Care Linked to Improved Aging-in-Place Outcomes

A new study published in JAMA Health Forum reveals that increased state investment in home- and community-based services (HCBS) significantly improves the ability of older adults to age in place. By analyzing data from over 7 million seniors, researchers found that prioritizing HCBS over institutional care reduces the likelihood of relocation to nursing homes or moving in with adult children. These findings highlight the critical role of public funding in supporting the residential stability and independence of the rapidly growing U.S. aging population.

The study, which utilized U.S. Census Bureau American Community Survey records from 2009 through 2021, examined the living situations of 7.35 million older adults with independent living difficulties. Researchers found that when states allocate a larger portion of their long-term services and support (LTSS) budgets to HCBS, seniors are more likely to remain in their own homes. Specifically, a 20-percentage-point increase in a state’s share of HCBS spending was associated with a 2.6-percentage-point reduction in the likelihood of residents living in institutional or congregate settings.

Beyond reducing institutionalization, the data showed that stronger HCBS systems help maintain family structures and residential stability. The same 20-percentage-point spending increase was linked to an 0.8-percentage-point decrease in seniors living with their adult children and a 1-percentage-point increase in individuals remaining in their original residences. The study also noted lower rates of both in-state and out-of-state moves among this demographic, suggesting that access to in-home assistance mitigates the need for functional-related relocations.

The implications for the senior care sector are significant, as the findings support a shift toward non-institutional care models and workforce development in the home-care space. While public programs are vital, the report acknowledges that many families still rely on personal resources, such as home equity and reverse mortgages, to fund necessary home modifications and care services. As the U.S. population continues to age, policymakers and care providers are under increasing pressure to expand HCBS options to meet the overwhelming preference of older adults to maintain autonomy and community ties.