In 2021, more than 100 economists and public policy scholars signed an open letter supporting investments in home-and-community-based services (HCBS) that address the caregiving needs of elderly Americans. “Investing in home care,” they wrote, “makes economic sense: it will create jobs, seniors and their families prefer it, it will reduce spending by shifting people out of nursing homes and improve care outcomes.”   The challenge, however, is not whether to provide the elderly with HCBS, but precisely how. To do the most good with limited resources, which services should be offered to whom? Faced with such complicated decisions, economists like to imagine quasi-experiments where you can vary the parameters and see what happens. In the case of HCBS, such interventions are actually being performed all the time. Specifically, federal Medicaid programs both cover and document nearly half of all spending on formal long-term care; differences across states in how they allocate that spending create an opportunity for learning which policies work best for whom.   To enable such research, PI Gal Wettstein and his team at Boston College’s Center for Retirement Research will compile and publish fine-grained data about how states have been, since 2000, changing their reimbursement plans for over 60 different HCBS services. Wettstein’s team has assembled resources like this in the past that many academics have cited, analyzed, and linked with other datasets. In this case, three papers are already planned and will be supported under the grant. The first of these concerns informal caregiving, specifically the impact of HCBS funding schemes on the probability that informal care is provided, on the hours of informal care provided, and on what types of help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are provided. The study will also assess how HCBS coverage affects the health and well-being of spousal caregivers, as well as the ability of adult child caregivers to move further away from the care recipient—perhaps in search of better employment or housing, for example. The second study concerns the workforce of formal caregivers, particularly how coverage of home care services affects labor market factors such as: the employment of registered nurses, licensed practical nurses, and nurse aides; the wages in these occupations; and their demographic composition. This is of special concern because the nurse aide workforce is typically low-wage, and disproportionally composed of immigrants and people of color. And the third research paper concerns health outcomes of long-term care recipients, including not only their probability of hospitalization, their rate of acquiring more ADL and IADL limitations, and their mortality rates, but also their self-assessed health and life satisfaction. While some literature suggests that more generous spending on HCBS overall does improve health outcomes, say by reducing unnecessary hospitalizations, researchers have previously been unable to isolate which types of services are particularly effective without the detailed data this project will provide.