• The types of interventions evaluated in home and community-based services (HCBS) studies involved optimization of person-centered planning, nonpharmacological approaches for dementia care, physical rehabilitation to improve function, collaborative care models, home-based palliative care programs, home care via telehealth, self-directed home care, geriatric resources for practical support at home, and delivery of specific services (e.g., skilled nursing, physical therapy, occupational therapy, home health aide, and case management).
• Although most HCBS serve people with disabilities across the lifespan, this Technical Brief focused on older adults with and without disabilities. Populations studied in HCBS literature included those with functional disability, cognitive impairment, high risk/frail conditions, and people with specific conditions, most commonly Parkinson disease, Alzheimer disease, or end-stage kidney disease.
• Outcomes evaluated in HCBS studies can be categorized as clinical outcomes (surrogate and final outcomes), person-centered outcomes, caregiver outcomes, utilization outcomes, and economic outcomes.
• The available literature had a focus on medical interventions with less focus on health-related social needs, such as housing, transportation, and nutrition.
• Determining whether a published study used a person-centered intervention or how involved individuals receiving HCBS were in selecting and using the services they received was not explicitly described in most of the available publications.
• Few studies evaluated person-centered outcomes, quality-of-life, satisfaction, social isolation, or caregiver outcomes.
• Tokenistic use of the term person-centered in the literature is possible and hard to ascertain. Therefore, in addition to using person-centeredness as a characteristic of HCBS interventions, it may also be considered as a quality indicator of the intervention to assure fidelity to this concept.
• Factors that potentially affect HCBS interventions include a person’s demographics and level of disability; the knowledge, skills and training of caregivers and providers; the person-centeredness of the intervention; level of multidisciplinary teamwork and coordination; and providers’ organizational process and culture.
• Determining whether person-centeredness impacted the effectiveness of HCBS interventions was not possible.
• Numerous quality measures exist for HCBS. Some of them are validated, address multiple person-centered domains, and can apply across various conditions and populations.

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/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.

Wang Z, Chen CYY, Njeru JW, Nayfeh T, Saadi S, Viola KE, Prokop LJ, Murad MH. Evidence Map on Home and Community-Based Services. [Technical Brief] No. #. (Prepared by the Mayo Clinic Evidence-based Practice Center under Contract No. 75Q80120D00005/75Q80123F32004.) Rockville, MD: Agency for Healthcare Research and Quality. September 2024. Available at: https://effectivehealthcare.ahrq.gov/products/search