Home and Community-Based Service Use by Vulnerable Older Adults

Home and community based services (HCBS) are designed to provide services that meet the increasing and diverse needs of the older adult population who wish to age-in-place for as long as possible in their homes and community. Yet, little is known about the choices people make when selecting services. The purpose of this study was to assess HCBS use among vulnerable older adults. Andersen’s (1995) behavioral model of health services use provided theoretical guidance for selecting and explaining predisposing, enabling, and need-based variables associated with service use within the Community Living Program (CLP) federal initiative. Through consumer direction of services, 18 routine or one-time services were offered to 76 participants enrolled in the Virginia CLP. Two-step cluster analysis identified four distinct profiles of service users, ranging in size from 7 to 34 members. Services used within the groups ranged from 11 to 16 services. Use of personal care services (p=.033) and respite (p=.010) were significantly associated with group membership differentiation. Within each cluster, the percentage of participants using each service varied greatly. The most important variables that differentiated service user membership were caregiver relationship to participant, participant living arrangement, participant disability type, and length of time caregiver provided care. Between-cluster membership was significantly different with regard to average service cost per day for services used (p=.002) and the likelihood of moving to a nursing home if services were not provided (p=.034). Findings inform future research and have implications for practitioners assisting vulnerable older adults in selecting services to meet different care needs.