Home- and community-based care is frequently touted as a key solution to the many ills of the current health care system as it serves, or doesn’t serve, our elderly patients and citizens. Lack of access to timely and appropriate home- and community-based care is often identified as a key bottleneck in many health care settings, contributing to overcrowding in the emergency departments and bed shortages in hospitals. Risks associated with institutionalized care such as pressure ulcers, falls, polypharmacy, and even a decreased quality of life that can come from depersonalized care and lack of purpose are increasingly viewed as troublesome. The proffered solution to this situation is often person-centred services in a home- or community-based setting. From a budgetary standpoint, home- or community-based care is also put forward as an antidote to expensive institutional care and long hospital stays. Innovative ways to deliver care to older adults that allow them to remain in their own homes or communities at a maximum level of independence are held up as solutions to these complex system problems. Home- and community-based services that maximize independence and autonomy are also cited as opportunities to provide dignified, person-first care that is argued to be cost-effective. This book aims to look at what services exist to serve the growing care needs of older adults outside the institutional long-term care and hospital-based settings.
Home- and community-based services (HCBS) are defined here as “health care and support services delivered to the residence and neighborhoods where older adults and their family caregivers live”. The intended audience is “students in the health professions, such as nursing, social work, and allied health services. … [as well as] students in public health and health care management fields.” The audience could also be broadened to include not just students in those fields, but also administrators and medical providers who care for patients who are, or should be, receiving care in a home- or community-based setting. The book is written from an American perspective with a focus on American government policies and funding models; however, the concepts and models of care that are presented can be of interest to readers from other countries.
The book is arranged so that the first four chapters provide a foundation to understand the different models of care that are reviewed in the remaining chapters. After the introductory chapter that provides a foundation for understanding the demographic characteristics of the older adult population in the United States, the authors dedicate two chapters to outline the American policies that affect HCBS and summarize the impact of the Older Americans Act. Neither chapter is particularly relevant to the Canadian reader, but they do lay important foundations for understanding the American context. After a review of the multidisciplinary and interdisciplinary skills across HCBS settings in chapter 4, the next seven chapters each focus on one model or facet of HCBS. The models that are reviewed include family caregiving, home health care services, the village concept and naturally occurring retirement communities, home-based primary care, assisted living and housing with services, adult day services, and hospice in community settings. The book concludes with a chapter considering the international perspectives on HCBS and an intriguing chapter about technology in HCBS.
The book is well researched with ample references for each model. The chapters are arranged so that there are clearly stated objectives, true and false questions, a chapter summary, and questions for further discussion. Chapters also include brief interviews that are “perspectives from the field”. At times having so many different sections within each chapter can detract from key points, but the summary at the end of each chapter is helpful.
This book provides a comprehensive review of many of the service models that exist in North America for older adults aging in place. Although no one model will fit all needs or personal preferences, this book helps readers to understand some of the strengths and limitations of each model of care. Perhaps most helpful is the book’s articulating what the authors view as the future challenges and opportunities for each model of care. All of us who work with or advocate for older adults, and for a more person-centred approach to care, need to understand what models of care currently exist. If nothing else, this understanding can help us to innovate newer models in the future. This book provides important background information and, as such, is relevant and timely.
