Home and Community-Based Services (HCBS)
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Types of HCBS Care
Health Services meet medical needs
- Home health care, such as:
- Skilled nursing care
- Therapies: Occupational, speech, and physical
- Dietary management by registered dietician
- Pharmacy
- Durable medical equipment
- Case management
- Personal care
- Caregiver and client training
- Health promotion and disease prevention
- Hospice care (comfort care for patients likely to die from their medical conditions)
Human Services support daily living
- Senior centers
- Adult daycares
- Congregate meal sites
- Home-delivered meal programs
- Personal care (dressing, bathing, toileting,eating, transferring to or from a bed or chair, etc.)
- Transportation and access
- Home repairs and modifications
- Home safety assessments
- Homemaker and chore services
- Information and referral services
- Financial services
- Legal services, such as help preparing a will
- Telephone reassurance
Benefits and Challenges of HCBS
Creating and maintaining an HCBS program benefits the community and the individuals served in many ways. However, there are several challenges to consider that come along with this type of program.
Benefits
- Cost effectiveness: usually less than half the cost of residential care
- Culturally responsive: spiritual and cultural activities and support available
- Familiarity: patient enjoys the comfort of their own home or small residential facility in the community
- Can provide counseling or clergy to assist with bereavement
Some waivers permit family members to be paid caregivers
Challenges
- Access to providers
- Availability of qualified caregivers
- Caregiver burnout
- Lack of 24/7 medical professional availability
- Nonfamily caregivers may have limited access in remote locations, especially during winter
- Potential cultural bias or barriers in the acuity assessment process
- Skilled nursing care includes only medical services performed by a registered nurse. Other daily tasks fall primarily to family members
- Those needing care do not always want family members to act as their caregivers due to potential for abuse or financial manipulation
- Tribes need to complete processes that are often long and complex, such as creating an elder abuse code or establishing a memorandum of understanding with the state, to create an HCBS program
