Home and Community-based Services Coordination for Homebound Older Adults in Home-based Primary Care
Gregory J. Norman*, Amy J. Wade, Andrea M. Morris and Jill C. Slaboda
The document discusses a study on the coordination of home and community-based services (HCBS) for homebound older adults within home-based primary care (HBPC) systems. It explores how these services are managed to address the non-medical social needs of older adults, who are often medically complex and vulnerable. The study used an online survey of members from the American Academy of Home Care Medicine, covering various aspects of HBPC practices such as identifying social needs, coordinating services, and the barriers faced in this coordination.
The findings from the survey indicate that nearly all HBPC practices assess the social needs of their patients, with the majority conducting assessments at intake and periodically thereafter. Most practices also engage in coordinating HCBS for their patients, which includes activities like following up with patients, assisting with applications, and making service referrals. Commonly reported challenges in coordinating these services include the high cost to patients, stringent eligibility requirements for services, and difficulties in insurance coverage, which are compounded by a lack of available local service providers and time delays in service provision.
The study concludes that despite the challenges, most HBPC practices manage to provide some level of coordination for HCBS, which is crucial for allowing high-need, high-cost homebound patients to remain in their homes. It highlights the need for more efforts to implement and scale care model partnerships between medical and non-medical service providers. To improve the efficacy and ease of coordinating HCBS, the study suggests potential solutions like having a designated point person within practices to manage service coordination and developing more integrated care models that align Medicare payment incentives with the provision of high-quality care.
