To test the relationship between older Americans Act (OAA) program expenditures and the prevalence of low-care residents in nursing homes (NHs).

Data Sources and Collection

Two secondary data sources: State Program Reports (state expenditure data) and NH facility-level data downloaded from for 16,030 US NHs (2000–2009).

Study Design

Using a two-way fixed effects model, we examined the relationship between state spending on OAA services and the percentage of low-care residents in NHs, controlling for facility characteristics, market characteristics, and secular trends.

Principal Findings

Results indicate that increased spending on home-delivered meals was associated with fewer residents in NHs with low-care needs.


States that have invested in their community-based service networks, particularly home-delivered meal programs, have proportionally fewer low-care NH residents.