Low-Care Nursing Home Residents in Missouri

Missouri

A 2021 AARP survey found that 77% of older adults wanted to live in their current residence for as long as possible. Aging in place has been shown to have physical, social and emotional benefits, resulting in better health outcomes compared with aging within a nursing home. Nursing homes can be the best or only source of housing and round-the-clock care for those unable to care for themselves. However, some nursing home residents are considered low care, meaning they require no physical assistance in bed mobility, transferring, toileting or eating. Low-care nursing home residents may be able to live in a less restrictive environment where they can receive less intensive care through home- or community-based services, or in alternative settings such as assisted living facilities.

Not only are nursing homes restrictive for people who do not need them, but they are also expensive compared with other care options. The cost of a private room in a nursing home in the United States averages $253 per day, or $7,698 per month. 

Older adults who are more likely to enter nursing homes despite low-care needs include:

• Those diagnosed with anxiety.
• Those without access to personal care services.

Examples of services that help older adults age in their homes include visiting home health aides, transportation programs and home- or community-based services such as Meals on Wheels. The Older Americans Act (OAA) provides federal funding to states for these services. States with greater investment in home-delivered meal programs have a lower proportion of low-care nursing home residents. In the 2021 National Survey of OAA participants, 89% said that the program helps them continue to live independently.

Research suggests that state investment in personal care services can help older adults remain in their homes and lead to Medicaid savings by reducing spending on long-term care services. One study estimated that if every state had increased the number of older adults receiving home-delivered meals in 2009 by just 1%, it would have saved the U.S. more than $109 million in state Medicaid programs and kept an additional 1,722 older adults with low-care needs out of nursing homes.

Increasing the availability of beds in assisted living facilities can also lead to a small but significant decrease in the percentage of low-care individuals entering nursing homes in that area. This effect is even more significant in areas with high rates of dual eligibility, or Medicare beneficiaries who also receive Medicaid. 

The Centers for Medicare & Medicaid Services offers more information and resources on nursing home alternatives.

Binette, Joanne. “Home and Community Preferences 2021: Age Breaks Annotated Questionnaire.” Washington, D.C.: AARP Research, November 18, 2021. https://doi.org/10.26419/res.00479.002.

Buttar, Amna, Caroline Blaum, and Brant Fries. “Clinical Characteristics and Six-Month Outcomes of Nursing Home Residents with Low Activities of Daily Living Dependency.” The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 56, no. 5 (May 2001): M292-297. https://doi.org/10.1093/gerona/56.5.m292.

Cornell, Portia Y., Wenhan Zhang, and Kali S. Thomas. “Changes in Long-Term Care Markets: Assisted Living Supply and the Prevalence of Low-Care Residents in Nursing Homes.” Journal of the American Medical Directors Association 21, no. 8 (August 2020): 1161-1165.e4. https://doi.org/10.1016/j.jamda.2020.01.006.

Hahn, Elizabeth A., Kali S. Thomas, Kathryn Hyer, Ross Andel, and Hongdao Meng. “Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs.” The Gerontologist 51, no. 4 (August 1, 2011): 495–503. https://doi.org/10.1093/geront/gnr020.

Marek, Karen Dorman, Lori Popejoy, Greg Petroski, David Mehr, Marilyn Rantz, and Wen-Chieh Lin. “Clinical Outcomes of Aging in Place.” Nursing Research 54, no. 3 (June 2005): 202–11. https://doi.org/10.1097/00006199-200505000-00008.

Thomas, Kali S. “The Relationship between Older Americans Act In-Home Services and Low-Care Residents in Nursing Homes.” Journal of Aging and Health, December 10, 2013. https://doi.org/10.1177/0898264313513611.

Thomas, Kali S., and Vincent Mor. “Providing More Home-Delivered Meals Is One Way to Keep Older Adults with Low Care Needs out of Nursing Homes.” Health Affairs 32, no. 10 (October 2013): 1796–1802. https://doi.org/10.1377/hlthaff.2013.0390.