Evidence Map on Home- and Community-Based Services and Person-Centered Care for Older Adults [Internet]

Excerpt

Background: People who receive home- and community-based services (HCBS) have diverse and unique needs that can be met with these services aiming to support their independence.

Purpose: To map the existing literature on HCBS in terms of interventions, populations, outcomes, person-centeredness, and relevant quality measures, and identify research gaps for older adults.

Methods: A comprehensive literature search of multiple databases including Medline, Embase, and Scopus was conducted up to December 7, 2023, and complemented with grey literature search and feedback from Key Informants. Eligible studies evaluated HCBS interventions in adults aged 60 years or older with a functional limitation requiring assistance with activities of daily living.

Findings: We identified 27 primary studies, 25 systematic reviews, and 29 quality measures. The most common types of interventions evaluated in HCBS studies involved optimization of person-centered planning, nonpharmacological approaches for dementia care, physical rehabilitation, collaborative care models, home-based palliative care programs, home healthcare via telehealth, self-directed home care, geriatric resources for practical support at home, interdisciplinary care coordination for high-risk conditions and delivery of specific services. Populations studied in HCBS studies included those with functional disability, cognitive impairment, high-risk or frail conditions, and people with specific conditions, most commonly Parkinson’s disease, Alzheimer’s disease, or end-stage kidney disease. Person-centered planning and self-direction of HCBS services were not explicitly described in most of the primary studies, and very few of these studies focused on addressing health-related social needs, whereas the majority had primary outcomes that can be considered medical or clinical. Numerous quality measures exist for HCBS. Some of them are validated, address multiple person-centered domains, and can apply across various conditions and populations. Key challenges in the literature on HCBS include lack of randomized trials, inadequate descriptions of interventions to determine person-centeredness, and limited information on facilitators and barriers. Because of the variability in how person-centeredness is operationalized in HCBS interventions, Key Informants reinforced the need to evaluate person-centered outcomes as a quality indicator of HCBS interventions. Key Informants also highlighted workforce challenges in recruiting, retaining, and training personnel delivering HCBS.

Conclusion: This evidence map summarizes the HCBS literature in terms of interventions, populations, outcomes, and relevant quality measures for older adults and older adults with disabilities.