Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care

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.

Care in the Silver Years: Academics Perception of Institutional Care for the Elderly in Ghana

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Social networks and links to isolation and loneliness among elderly HCBS clients

“…There is a substantial literature comparing the relative effectiveness of community-based versus institutional care (Wysocki et al, 2012). Previous studies have compared the demographic and health characteristics of care recipients, the services received and the functional, medical and psychological outcomes associated with each.…”

Factors Associated With Discharge to Home Versus Discharge to Institutional Care After Inpatient Stroke Rehabilitation

“…12,17,18 There is little information on which specific patient characteristics can be used to predict a home versus institution disposition from inpatient rehabilitation. [19][20][21][22][23][24] The purpose of this study was to examine sociodemographic and clinical characteristics independently associated with discharge home compared with discharge to a skilled nursing facility (SNF) after acute inpatient rehabilitation.…”