Home and Community Based Services (HCBS) offer support to older adults who wish to grow old in their own homes, and previous research has shown they can help prevent nursing home usage; however, very little is known about what mechanisms make the programs succeed or fail. University of Washington researchers tried to delineate the factors that help ensure their success. Using data from the Second Longitudinal Study of Aging, they surveyed about 5,294 older adults to conduct Structural Equation Modeling in an effort to pinpoint factors that predict whether an older adult is able to stay in his/her home or not.
After comparing the impact of HCBS services on the older adults’ ability to stay in the home, the researchers found that participating in paid services for instrumental activities of daily living (IADL) and having a high awareness of what the typical unmet needs are for older adults helped research participants stay in their homes longer than others.
Interestingly, the use of other types of services (free IADLs, non-IADL services) did not show any added benefit for staying in the home. Furthermore, many older adults rely on supportive services from family and friends. Oftentimes, when these services become too burdensome for the family or friends, the next place they look to for help is the nursing home, often against the wishes of the older adult. A greater awareness of fee-for-service IADL programs may help families make decisions that are more in tune with their loved one’s wishes. Ironically, the people with greater informal social support services were much less likely to use paid IADL services, the only HCBS service shown to be important for preventing nursing home stays.
The finding that paid IADL services has a positive impact on older adults’ abilities to remain in the community is an important one. If these services are robust enough, they will offer a sensible alternative to nursing homes and help reduce the sense of powerlessness and self-degradation that nursing home residents often feel upon admittance.
Source: Chen, Y. Adams Thompson, E. 2010. Understanding factors that influence success at Home and Community Based Services in keeping older adults in community settings. Journal of Aging and Health (Online First): 1-25 (forthcoming in print).
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Clear that paid IADL services are helpful but unclear if unpaid IADL services are?
Wouldn’t informal supports who provide unpaid IADL services be helpful, “Furthermore, many older adults rely on supportive services from family and friends..”
You point out something that I thought was a flaw in this study. It was a statistical study and I wondered if they had the proper controls. Theoretically they seem to but I wonder if these unpaid IADL services, which are more likely used by lower income older adults have an impact that is masked by the fact that lower income older adults also tend to have lower reported levels of health and quality of life.
Very important point. Thanks for the comment!