Home & Community Based Services

Home and Community Base Service

In the 1970s and 1980s social policy makers in the United States became aware that the long-term care system needed far-reaching change to effectively serve the needs of the burgeoning senior population. The system was gragmented and limited. Often the only available option for seniors like Dotty Strum and Jan Tompkins was entering a nursing home. Since that time services that enable seniors to remain independent in the housnig of their choice have flourished across the country.

Home and community-based services (HCBS) are popular in the field of aging because they exemplify a social policy away from nursing homes and toward independent living and consumer control. Many communities now have an impressive continuum of long-term supportive services available for seniors. The goal of the programs is to help people with physical limitations live outside of institutions and in their own homes. Some community programs have developed as the result of government funding. Many are run by not-for-profits, others are businesses. Some are free, others are available only to seniors who meet certain qualifications, and others require payment. Such programs fall under the umbrella terms of home and community-based services or long-term supportive services. This chapter will use the two terms interchangeably.

It is important for you to be aware of the long-term supportive services offered in your community so that you can refer your clients to them if and when the need arises. Armed with this knowledge, you can be instrumental in keeping your clients out of nursing homes.

Independent living is not doing things by yourself.

It is being in control of how things are done.

Judith E. Herman

Overview of HCBS

By definition, home and community-based services allow people of all ages who have physical limiations to remain independent in the least restrictive settings possible and to be connected with their communities. The availability of HCBS in a community can make the difference between a senior living at home and having to live in a nursing home. Usually some form of home care is central to HCBS.

Home and community-based services usually work in conjuncion with an informal support network. Such networks are composed of family members, friends, and neighbors who care for people of any age who face chronic illness or disability.

A recent study funded by AARP took an in-depth look at the roles of supportive services to enhance the independence of people ages 50 and older with disabilities. When the researchers asked open-ended questions about the respondents' hopes and concerns, the number-one fear they named was loss of independence. Control over decision-making was also a major theme (AARP, 2003).

The following are some of the comments made by the 53 percent of AARP's respondents who answered yes to the question, "Have there been times in the past month when you could not do something you really needed or wanted to do because of your disability or health condition? (AARP, 2003, p.7):

"I would like to just go for a ride."

"Walk on the beach."

"Pay my bills, nothing else."

"Make a minor car repair, walk to the corner, get something off a high shelf, tie my shoes."

"Just get out of bed."

"Just get back and forth to the store."

"I can hardly go to visit relatives because of the stairs."

"Go to the park with my grandchildren."

These responses reflect the daily challenges faced by seniors with physical limitations.

The information above is reprinted from Working with Seniors: Health, Financial and Social Issues with permission from Society of Certified Senior Advisors® . Copyright © 2009. All rights reserved. www.csa.us