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An article in the July 2019 issue of Health Affairs, “A National Examination Of Long-Term Care Setting, Outcomes, And Disparities Among Elderly Dual Eligibles,” relayed findings from a national study on home and community-based services (HCBS) use and outcomes among dual-eligible beneficiaries. The study found that the racial/ethnic disparities in access to high-quality institutional long-term care were also present in HCBS.

One aspect of the study examined hospital admissions by race/ethnicity and dementia, limiting the main analysis of hospitalizations to the groups who used only institutional services or only HCBS, setting aside those who used care in both settings, among other limitations outlined in the article. “When we examined HCBS users more closely, we found that blacks had the highest rates of hospitalizations, including potentially avoidable hospitalizations, followed by non-Hispanic whites and Hispanics, and finally Asians/Pacific Islanders. These patterns held across beneficiaries both with and without dementia. For each racial/ethnic group, not surprisingly, there were higher rates of any hospitalizations and of potentially avoidable hospitalizations among care recipients with dementia, but the presence of dementia exacerbated the differences in hospitalization rates by race/ethnicity. In other words, among those without dementia, blacks had higher rates of hospitalizations than members of other racial/ethnic groups, but among those with dementia, the difference between blacks and others became more pronounced.”

The research and findings could help inform policy initiatives focused on the effects of the shift in resources from nursing facilities to HCBS.

The article is available at: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05409

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