Background and objectives: Home and community-based services (HCBS) intend to allow individuals to age in their home or a home-like environment. The relationship between receiving specific types of HCBS and person-reported HCBS quality remains unclear.
Research design and methods: We linked data on HCBS quality from 1413 respondents of the 2018 Minnesota National Core Indicators-Aging and Disability survey with claims from the Minnesota Department of Human Services Medicaid Management Information System. Among this sample of HCBS users, we used linear regression to evaluate the association between using specific types of HCBS (home health services; non-medical transportation; personal care assistant services; case management; adult day care; durable medical equipment/home modifications; and homemaker services and person-centered HCBS quality). Our regression models included an interaction between HCBS utilization and whether a respondent had a diagnosis of dementia. We stratified analyses between people living in the community and assisted living.
Results: Using personal care assistant services was associated with significantly higher-quality scores among community-dwelling HCBS users. Using home health care, durable medical equipment/home modifications, non-medical transportation, homemaker services, and adult day care were not significantly associated with quality scores among HCBS users. On average, HCBS users with dementia reported lower quality scores than their counterparts without dementia. Among assisted living residents, quality was lower for people with dementia who did not use non-medical transportation or case management; however, this difference was not significant among users of these services. In the assisted living sample, analyses of quality subdomains found significant associations with service use that were not present when evaluating overall quality scores.
Discussion and implications: Personal care assistant services may be associated with higher quality among people in the community because this service supports activity of daily living and provides social interaction.
