Home and Community-Based Service Use Varies by Health Care Team and Comorbidity Level of Veterans with Dementia

Emma D. Quach, Emily Franzosa, Shibei Zhao, Pengsheng Ni, Christine W. Hartmann, Lauren R. Moo

Research output: Contribution to journalArticlepeer-review

Abstract

Home and community-based services (HCBSs) such as home care and adult day centers are vital to supporting adults with dementia in community settings. We investigated whether HCBS use (use of both home care and adult day, use of one service, and use of neither service) varied between adults receiving care from three types of health-care teams with case management from social workers and nurses, and by comorbidity level, using 2019 data of 143,281 patients with dementia in the Veterans Health Administration. We compared HCBS use by patients’ type of case-managed team (Home-Based Primary Care, geriatrics-based primary care, and dementia-focused specialty care) to patients in none of these teams, stratified by patients’ non-dementia comorbidities (<4 or ≥4). Each type of health-care team was associated with both home care and adult day services, at each level of comorbidity. Home-Based Primary Care was most consistently associated with other forms of HCBS use, followed by Dementia Clinics and geriatrics-based primary care, for patients with ≥4 non-dementia comorbidities. Our findings suggest that case management in primary and specialty care settings is a contributor to the use of critical community supports by patients with the most complex needs.

Original languageEnglish
Pages (from-to)242-257
Number of pages16
JournalJournal of Gerontological Social Work
Volume67
Issue number2
DOIs
StatePublished - 2024

Keywords

  • Home and community-based services use
  • case management
  • dementia

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