Changes in Service Utilization and Unmet Needs in HCBS in the United States During the COVID-19 Pandemic

TL;DR

This study examines how the use of home-and community-based services changed and how unmet needs evolved among older adults in the U.S. during the pandemic compared to before.

Contribution

The study provides new insights into how specific HCBS utilization and unmet needs changed during the pandemic across six service types.

Findings

Personal care and caregiver respite/service use increased during the pandemic.

Unmet needs increased for personal care and meal delivery but decreased for caregiver respite/support.

Service utilization changes varied significantly across different HCBS types.

Abstract

More than 5 million older adults in the United States use publicly-funded home-and community-based services (HCBS) which were disrupted during the COVID-19 pandemic. We evaluated changes in HCBS use and consumer-reported unmet HCBS needs during the pandemic (2021-2022) versus pre-pandemic (2018-2019). We evaluated six commonly used HCBS: personal care, homemaker, meal delivery, adult day, transportation, and caregiver respite/support services. We used mixed effects logistic regression modeling to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI), adjusting for consumers’ sociodemographic and health-related characteristics, with random intercepts for state. We included community-dwelling, HCBS consumers (age, ≥65 years) from 11 states that participated in both- 2018-2019 and 2021-2022 survey waves. Compared to 2018-2019, service use increased for personal care (OR, 1.24; 95% CI, 1.09, 1.40) and caregiver respite/support (OR, 1.28; 95% CI, 1.00, 1.63) but decreased for homemaker services (OR, 0.69; 95% CI, 0.60, 0.79) and meal delivery (aOR, 0.81; 95% CI, 0.70, 0.93). In 2021-2022, unmet HCBS needs significantly increased for personal care (OR, 1.23; 95% CI, 1.03, 1.46) and meal delivery (OR, 1.26; 95% CI, 1.01, 1.56) but significantly decreased for caregiver respite/support (OR, 0.49; 95% CI, 0.35, 0.70). During the pandemic, changes in service utilization and consumer-reported unmet service needs differed between various types of HCBS. These findings can inform disaster preparedness efforts for assuring continuity of HCBS during future public health emergencies.