Over the past three decades, there has been a large expansion in noninstitutional long‐term care (LTC) use, and public financing of long‐term care services has been shifting away from nursing homes toward home and community‐based services (HCBS). Medicaid, the primary payer for LTC for elderly people, spent 46% of its total LTC dollars on HCBS on average as of 2013, up from 13% in 1990. The rationale for this expansion is based mainly on two assumptions: (a) LTC users generally prefer HCBS to institutional care, and (b) for nursing home residents with less intensive care needs, HCBS may be cheaper.
Although family members usually participate in LTC decisions and are inevitably affected by the decision to use HCBS in lieu of nursing home care, prior studies in this area have mainly focused on the preferences and well‐being of LTC users in different care settings. The desirability of HCBS among the family members is often taken as self‐evident. Yet it remains unclear whether and how HCBS (vs institutional care) use may affect health outcomes for the family members of care recipients—especially the spouses—who are themselves typically elderly and potentially vulnerable, yet play an important role in providing care and making LTC decisions. This issue is largely ignored in the drive to expand HCBS and estimates of the overall potential cost savings associated with HCBS.Research Article, National Institute on Aging