TY - JOUR
T1 - Long-Term Services and Supports for Older Adults
T2 - A Review of Home and Community-Based Services Versus Institutional Care
AU - Wysocki, Andrea
AU - Butler, Mary
AU - Kane, Robert L.
AU - Kane, Rosalie A.
AU - Shippee, Tetyana
AU - Sainfort, François
PY - 2015/7/3
Y1 - 2015/7/3
N2 - 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.
AB - 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.
KW - comparative effectiveness review
KW - home- and community-based services
KW - nursing homes
UR - http://www.scopus.com/inward/record.url?scp=84937196411&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84937196411&partnerID=8YFLogxK
U2 - 10.1080/08959420.2015.1024545
DO - 10.1080/08959420.2015.1024545
M3 - Article
C2 - 25942005
AN - SCOPUS:84937196411
SN - 0895-9420
VL - 27
SP - 255
EP - 279
JO - Journal of Aging and Social Policy
JF - Journal of Aging and Social Policy
IS - 3
ER -