Regional Variation in Economic Values of Unpaid Care for Individuals with Alzheimer's Disease and Other Dementias and Medicare Nursing Home Expenditures for Long-Term Care

Alzheimer's disease (AD) and other dementias create substantial burden on the United States economy.  In 2012, the total Medicare nursing home expenditures for long-term care (LTC) services totaled more than $29.96 billion, while 15.4 million caregivers supplied a projected 17.5 billion hours of uncompensated care with an estimated economic value of more than $216 billion.  Data from the Alzheimer’s Association and the Centers for Medicare & Medicaid Services were used to conduct a cross-sectional analysis to assess if an association exists between the economic value of unpaid care and Medicare nursing home expenditures in the United States in 2012. Per capita aged 75+ was calculated using individual state population data from the 2010-2011 Census Bureau Current Population Survey. Fiscal capacity, fiscal effort, and federal generosity for Medicaid spending among the states and the District of Columbia were calculated as possible sources of variation for Medicare nursing home expenditures. Clustering effects and regional variation were revealed.  Rural states have lower Medicare expenditures and display lower levels of fiscal capacity and fiscal effort, while a cluster of rural and southern states reveal higher economic values of unpaid care. In contrast, northeastern and midwestern states display higher spending on Medicare nursing home care and lower levels of federal generosity.  The relationship of informal caregiving and its utility to offset Medicare nursing home expenditures offer insight to health policies surrounding long-term care.