Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care |
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| Authors: | Andrea Wysocki Mary Butler Robert L Kane Rosalie A Kane Tetyana Shippee François Sainfort |
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| Institution: | 1. Researcher, Mathematica Policy Research, Washington, DC, USAawysocki@mathematica-mpr.com;3. Assistant Professor, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA;4. Professor, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA;5. Senior Partner, BioMedical Metrics, LLC, Edina, Minnesota, and Adjunct Professor, University of Minnesota, Minneapolis, Minnesota, USA |
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| Abstract: | Despite a shift from institutional services toward more home and community-based services (HCBS) for older adults who need long-term services and supports (LTSS), the effects of HCBS have yet to be adequately synthesized in the literature. This review of literature from 1995 to 2012 compares the outcome trajectories of older adults served through HCBS (including assisted living AL]) and in nursing homes (NHs) for physical function, cognition, mental health, mortality, use of acute care, and associated harms (e.g., accidents, abuse, and neglect) and costs. NH and AL residents did not differ in physical function, cognition, mental health, and mortality outcomes. The differences in harms between HCBS recipients and NH residents were mixed. Evidence was insufficient for cost comparisons. More and better research is needed to draw robust conclusions about how the service setting influences the outcomes and costs of LTSS for older adults. Future research should address the numerous methodological challenges present in this field of research and should emphasize studies evaluating the effectiveness of HCBS. |
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| Keywords: | comparative effectiveness review home- and community-based services nursing homes |
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