Volume 54 | Number 1 | February 2019

Abstract List

Jing Dong PhD, MPH, Harold Pollack PhD, Rita Tamara Konetzka PhD


To provide empirical evidence on the effects of home and community‐based services () (vs nursing home) use on spousal health.

Data Sources

Merged data from the 1996 to 2012 Health and Retirement Study () and the Area Health Resource File ().

Study Design

We assess the impact of use on spousal health. We use an instrumental variable () 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.

Data Extraction Methods

Our sample includes spouses of or nursing home users, resulting in 8608 observations.

Principal Findings

We find that 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 at home relative to in an institution. Our results are important in estimating the potential cost and effectiveness of expansion.