Home and community-based services (HCBS) are a range of long-term care services intended to enable older adults and persons with disabilities to “age in place” in their own homes and communities. Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home. One study concluded that 84 percent of older Americans, aged 50 years and older, want to remain in their homes for as long as possible. Medicaid is a major source of funding for long term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional, and older adults and their families have relied on nursing homes to be the provider of long-term care.
In 2006, the national average of the proportion of Medicaid long-term care spending for disabled older adults and persons with disabilities going to institutional care was 75 percent, while 25 percent was directed towards HCBS. Similar to the national average, the proportion of Medicaid long-term care spending for institutional care in 2006 was greater than the proportion for HCBS in Massachusetts with 78 percent of Medicaid long-term care spending directed towards institutional care, and 22 percent going to HCBS. Moreover, in 2007, Massachusetts had nearly 25 percent greater rate of nursing home utilization than the national average. As of 2008, according to the Massachusetts State Profile Tool, approximately 60 percent of MassHealth (Massachusetts’ state Medicaid program) long-term care spending is spent on nursing facilities.
Wong, Cathy M. and Silverstein, Nina M., "Massachusetts’ Home Care Programs and Reasons for Discharge into Nursing Homes" (2011). Gerontology Institute Publications. Paper 35.