Has Increased Medicaid Spending on Home- and Community-Based Services Reduced Unmet Needs in Activities of Daily Living Care among Community-Dwelling Older Adults with Dementia? Evidence from 2008 to 2020.
Zijing Cheng, Hochang B Lee, Daniel D Maeng and 2 others
PMID 40449532WHAT IT FOUND
Putting a larger share of Medicaid long-term care dollars into home and community services was associated with fewer unmet ADL care needs in older adults with dementia.
Total spending did not show the same link. This is state spending data, not a therapy trial.
Key findings
01In adjusted models, a 10 percentage-point higher share of Medicaid long-term care spending allocated to home and community services was associated with a 23% lower odds of unmet ADL needs (OR 0.77, 95% CI 0.59-0.98).
02Total Medicaid long-term care spending was not significantly associated with unmet ADL needs.
03Nearly half of the community-dwelling adults with dementia in the sample reported at least one unmet ADL need.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
This is an observational study of state spending, not a trial of home services or therapy, so it cannot prove that spending caused fewer unmet ADL needs. The spending measure did not show who received services, how many services they used, or service quality. Dementia status came from survey cognitive screening or proxy reports, not clinical neuropsychological assessment. Unmet ADL need was based on self or proxy report, and proxy caregivers may underreport need. The count of 2,722 is respondent-waves, not unique people, because some respondents appeared in more than one wave. The sample came from 40 states and 384 counties, and the outcome was any unmet ADL need, not effects on each ADL.
Declared interests
Funding support is listed as NIH extramural and U.S. government non-PHS research. The article text does not state author conflicts.
The easy way to misread this
Do not conclude that more total Medicaid long-term care spending will reduce unmet ADL needs; total spending was not significant. Do not read the spending-share result as proof that home services or clinician actions caused the reduction; the study analysed state spending and survey reports, not delivered care.