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Long-term care service mix in the Veterans Health Administration after home care expansion.

Publication ,  Journal Article
Jacobs, JC; Wagner, TH; Trivedi, R; Lorenz, K; Van Houtven, CH
Published in: Health Serv Res
December 2021

OBJECTIVE: To determine whether the Veterans Health Administration's (VHA) efforts to expand access to home- and community-based services (HCBS) after the 2001 Millennium Act significantly changed Veterans' utilization of institutional, paid home, and unpaid home care relative to a non-VHA user Medicare population that was not exposed to HCBS expansion efforts. DATA SOURCES: We used linkages between the Health and Retirement Study and VHA administrative data from 1998 until 2012. STUDY DESIGN: We conducted a retrospective-matched cohort study using coarsened exact matching to ensure balance on observable characteristics for VHA users (n = 943) and nonusers (n = 6106). We used a difference-in-differences approach with a person fixed-effects estimator. DATA COLLECTION/EXTRACTION METHODS: Individuals were eligible for inclusion in the analysis if they were age 65 or older and indicated that they were covered by Medicare insurance in 1998. Individuals were excluded if they were covered by Medicaid insurance at baseline. Individuals were considered exposed to VHA HCBS expansion efforts if they were enrolled in the VHA and used VHA services. PRINCIPAL FINDINGS: Theory predicts that an increase in the public allocation of HCBS will decrease the utilization of its substitutes (e.g., institutional care and unpaid caregiving). We found that after the Millennium Act was passed, there were no observed differences between VHA users and nonusers in the probability of using institutional long-term care (0.7% points, 95% CI: -0.009, 0.022) or in receiving paid help with activities of daily living (0.06% points, 95% CI: -0.011, 0.0125). VHA users received more hours of unpaid care post-Millennium Act (1.48, 95% CI: -0.232, 3.187), though this effect was not significant once we introduced controls for mental health. CONCLUSIONS: Our findings indicate that mandating access to HCBS services does not necessarily imply that access to these services will follow suit.

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Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

December 2021

Volume

56

Issue

6

Start / End Page

1126 / 1136

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Medicare
  • Male
  • Long-Term Care
  • Humans
  • Home Care Services
  • Health Services Accessibility
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Jacobs, J. C., Wagner, T. H., Trivedi, R., Lorenz, K., & Van Houtven, C. H. (2021). Long-term care service mix in the Veterans Health Administration after home care expansion. Health Serv Res, 56(6), 1126–1136. https://doi.org/10.1111/1475-6773.13687
Jacobs, Josephine C., Todd H. Wagner, Ranak Trivedi, Karl Lorenz, and Courtney H. Van Houtven. “Long-term care service mix in the Veterans Health Administration after home care expansion.Health Serv Res 56, no. 6 (December 2021): 1126–36. https://doi.org/10.1111/1475-6773.13687.
Jacobs JC, Wagner TH, Trivedi R, Lorenz K, Van Houtven CH. Long-term care service mix in the Veterans Health Administration after home care expansion. Health Serv Res. 2021 Dec;56(6):1126–36.
Jacobs, Josephine C., et al. “Long-term care service mix in the Veterans Health Administration after home care expansion.Health Serv Res, vol. 56, no. 6, Dec. 2021, pp. 1126–36. Pubmed, doi:10.1111/1475-6773.13687.
Jacobs JC, Wagner TH, Trivedi R, Lorenz K, Van Houtven CH. Long-term care service mix in the Veterans Health Administration after home care expansion. Health Serv Res. 2021 Dec;56(6):1126–1136.
Journal cover image

Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

December 2021

Volume

56

Issue

6

Start / End Page

1126 / 1136

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Medicare
  • Male
  • Long-Term Care
  • Humans
  • Home Care Services
  • Health Services Accessibility