Abstract
BackgroundAs Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions.MethodsThe study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1) Community-Community-Community (CCC: Resided in community during the entire study period); (2) Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3); (3) Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3); (4) Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.).ResultsOlder adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS) and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other services, such as senior center services or meal services, were associated with different directions in residential transition, such as CIC and CII respectively.ConclusionsOlder adults’ differing HCBS use patterns may be the key to explaining older adults’ transitions. Attention to older adults’ HCBS use patterns is recommended for future practice. However, this was an exploratory study and the analyses cannot establish causal relationships.
Highlights
As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time
The policy questions asked in past research studies were whether older adults’ use of HCBS reduced their use of institutional services such as nursing homes
This was the first study to address the relationship between older adults’ HCBS use and their residential transitions. It was an exploratory study, and did not intend to disentangle the causal relationships among HCBS use, disability status, and residential transitions. This study addressed these two related questions: (1) whether there are differences in service use among groups of older adults defined by residential transition patterns; and (2) which HCBS are associated with which residential transition patterns
Summary
As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions. The policy questions asked in past research studies were whether older adults’ use of HCBS reduced their use of institutional services such as nursing homes. As HCBS have become increasingly available, it has become clear that older adults transit through different residential statuses over time. As more older adults in need express their preferences for HCBS care, understanding how older adults’ HCBS use relates to their residential transitions would provide useful information about cost-effective ways to develop HCBS for particular populations [3]
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