Systemic barriers hinder person-centered home and community based services (HCBS): Perspectives of service users and professionals

IF 3.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES Disability and Health Journal Pub Date : 2025-07-01 DOI:10.1016/j.dhjo.2024.101629

Niveda Tennety , Bridgette M. Schram , Jacqueline Kish , Tonie Sadler , Ross Kaine , Katie Kaufman , Steve Lutzky , Allen Heinemann

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Abstract

Background

In response to the 2014 Final Settings Rule issued by the Centers for Medicaid and Medicare Services, home-and-community based services (HCBS) provider organizations strengthened person-centered (PC) planning for HCBS to improve participants' choice and control over their services. Despite the call for widespread adoption of PC services, systemic barriers influence service users’ and professionals' experiences in receiving and delivering PC services.

Objective

This study describes the perspectives of HCBS professionals and users on systemic barriers that affect PC HCBS delivery.

Methods

Semi-structured interviews with 20 HCBS users and 22 HCBS professionals explored perspectives on providing and receiving PC HCBS as well as higher level systems challenges to providing PC services. Qualitative analysis focused on participants’ perspectives of system-level issues.

Results

Qualitative analysis generated three themes: (1) Workforce considerations; (2) Resources and service access; and (3) Infrastructure for feedback. High direct service provider turnover rates, service-eligibility determination procedures, and waitlists affected service delivery. Participants highlighted a need for increased direct service provider compensation, access to higher-quality training, improved financial resources, and effective feedback infrastructures. Waiver flexibility due to the Covid-19 public health emergency allowed expanded service access and improved quality.

Conclusion

Organizational and system-level issues hinder delivery of PC services. Increased flexibility and resource allocation for service provision, as demonstrated in the Covid-19 public health emergency response, should be sustained. HCBS users’ suggestions for service-delivery improvements are consistent with recent state and organizational initiatives. HCBS improvements benefit from user-identified solutions in program development and implementation.

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系统性障碍阻碍了以人为本的家庭和社区服务（HCBS）：服务使用者和专业人员的观点。

背景：为响应医疗补助和医疗保险服务中心发布的 2014 年《最终设置规则》，家庭和社区服务（HCBS）提供机构加强了以人为本（PC）的家庭和社区服务规划，以改善参与者对其服务的选择和控制。尽管人们呼吁广泛采用 PC 服务，但系统性障碍影响了服务使用者和专业人员在接受和提供 PC 服务时的体验：本研究描述了家庭护理服务专业人员和用户对影响个人护理家庭护理服务提供的系统性障碍的看法：对 20 名社区保健服务使用者和 22 名社区保健服务专业人员进行了半结构式访谈，探讨了他们对提供和接受个人护理社区保健服务的看法，以及提供个人护理服务所面临的更高层次的系统挑战。定性分析侧重于参与者对系统层面问题的看法：定性分析产生了三个主题：（1）劳动力考虑因素；（2）资源和服务获取；以及（3）反馈基础设施。直接服务提供者的高更替率、服务资格确定程序和等待名单影响了服务的提供。与会者强调，需要增加直接服务提供者的报酬、提供更高质量的培训、改善财政资源以及建立有效的反馈基础设施。由于 Covid-19 公共卫生紧急状况而产生的豁免灵活性允许扩大服务范围并提高服务质量：结论：组织和系统层面的问题阻碍了个人护理服务的提供。正如 Covid-19 公共卫生突发事件应对措施所展示的那样，在提供服务方面增加灵活性和资源分配应持续下去。HCBS 用户对服务提供改进的建议与近期州和组织的倡议是一致的。在计划制定和实施过程中，用户确定的解决方案将有助于改善 HCBS。

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来源期刊

Disability and Health Journal HEALTH CARE SCIENCES & SERVICES-PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

CiteScore

7.50

自引率

6.70%

发文量

134

审稿时长

34 days

期刊介绍： Disability and Health Journal is a scientific, scholarly, and multidisciplinary journal for reporting original contributions that advance knowledge in disability and health. Topics may be related to global health, quality of life, and specific health conditions as they relate to disability. Such contributions include: • Reports of empirical research on the characteristics of persons with disabilities, environment, health outcomes, and determinants of health • Reports of empirical research on the Systematic or other evidence-based reviews and tightly conceived theoretical interpretations of research literature • Reports of empirical research on the Evaluative research on new interventions, technologies, and programs • Reports of empirical research on the Reports on issues or policies affecting the health and/or quality of life for persons with disabilities, using a scientific base.