Abstract
This study examined whether better state LTSS performance in caregiver support (LTSS-CG), independent of LTSS spending, is associated with lower hospitalizations among community-dwelling older adults with dementia. Using Health and Retirement Study data (2012-2020) linked to the LTSS-CG state rankings, we analyzed hospitalization outcomes (any hospitalization, total hospital nights, total stays) for 6,755 participants. Multivariable regression models showed that worse LTSS-CG rankings were significantly associated with increased hospitalizations. Compared to states with "Excellent" LTSS-CG rankings, the odds of hospitalization were 35.13%, 36.09%, and 46.69% higher for "Good," "Fair," and "Poor" categories, respectively. Similarly, hospital stays and nights increased across lower-ranking categories. Findings suggest that better LTSS-CG is associated with lower hospitalization risks, highlighting the importance of accessible, high-quality LTSS for caregiver support in improving health outcomes and lowering dementia-related healthcare costs. This underscores the need for policies promoting caregiver support to foster healthy aging.