University of Chicago, Chicago, Illinois.
IMPAQ International, Columbia, Maryland.
Health Serv Res. 2019 Feb;54(1):158-166. doi: 10.1111/1475-6773.13053. Epub 2018 Sep 23.
To provide empirical evidence on the effects of home and community-based services (HCBS) (vs nursing home) use on spousal health.
Merged data from the 1996 to 2012 Health and Retirement Study (HRS) and the Area Health Resource File (AHRF).
We assess the impact of HCBS use on spousal health. We use an instrumental variable (IV) approach to account for the potential endogeneity of the choice of care setting and reverse causality. Our instrument is the supply of skilled nursing home beds per 1000 people older than 65 years.
Our sample includes spouses of HCBS or nursing home users, resulting in 8608 observations.
We find that HCBS use leads to harmful effects on spousal physical health, which may be caused by increased informal care responsibilities. We also find improved spousal mental health, especially in depression symptoms, which may be caused by increased satisfaction.
We find evidence of both beneficial (mental health) and harmful (physical health) consequences for spouses of individuals receiving LTC at home relative to in an institution. Our results are important in estimating the potential cost and effectiveness of HCBS expansion.
为家庭和社区为基础的服务（HCBS）（与养老院相比）使用对配偶健康的影响提供经验证据。
合并了来自 1996 年至 2012 年健康与退休研究（HRS）和地区卫生资源档案（AHRF）的数据。
我们评估了 HCBS 使用对配偶健康的影响。我们使用工具变量（IV）方法来解释护理地点选择的潜在内生性和反向因果关系。我们的工具是每 1000 名 65 岁以上的人中熟练的养老院床位供应。
我们的样本包括 HCBS 或养老院使用者的配偶，共 8608 例观察结果。
我们发现 HCBS 使用对配偶的身体健康产生了有害影响，这可能是由于非正式照顾责任的增加所致。我们还发现配偶的心理健康得到了改善，尤其是在抑郁症状方面，这可能是由于满意度的提高所致。
我们发现，与在机构中接受长期护理的个人相比，在家中接受长期护理的个人的配偶既有有益的（心理健康），也有有害的（身体健康）后果。我们的结果对于估计 HCBS 扩张的潜在成本和效果非常重要。
