Home- and community-based services (HCBS) for many older adults are an essential component of aging-in-place. Andersen developed the contemporary model used to predict service use. Researchers have modified the model to examine need. Studies that attempt to predict unmet needs have explained only 10% to 15% of the variance. This study is based on the supposition that lack of accounting for environmental factors has resulted in such small explanatory power. Through the use of 2008 Southeastern Pennsylvania Household Health Survey data, this exploratory study modeled predictors of unmet HCBS needs. Findings reveal that lack of access to healthy foods and poor housing quality have a significant relationship to unmet HCBS needs. This model predicted 54% of the variance. Results reveal environmental questions to ask, a way to identify older adults with unmet HCBS needs and environmental barriers that if addressed may reduce older adults’ eventual need for health services and HCBS.
AndersenR. M. (1968). Behavioral model of families’ use of health services (Research Series No. 25). Chicago, IL: Center for Health Administration Studies, University of Chicago.
2.
AndersenR. M. (1995). Revisiting the behavioral model and access to medical care: does it matter?. Journal of health and social behavior, 36(1), 1-10.
3.
AndersenR. M.NewmanJ. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Millbank Memorial Fund Quarterly: Health and Society, 51(1), 95-124.
4.
BradleyE. H.McGrawS. A.CurryL.BuckserA.KingK. L.KaslS. V.AndersenR. (2002). Expanding the Andersen model: The role of psychosocial factors in long-term care use. Journal of Health Services Research, 37, 1221-1243.
5.
CalsynR. J.RoadesL. A. (1993). Predicting perceived service need, service awareness, and service utilization. Journal of Gerontological Social Work, 21, 59-76.
6.
CalsynR. J.WinterJ. P. (2001). Predicting four types of service needs in older adults. Evaluation and Program Planning, 24, 157-166.
7.
CasadoB. L.VulpenK. S. V.DavisS. L. (2011). Unmet needs for home and community-based services among frail older Americans and their caregivers. Journal of Aging and Health, 23, 529-553. doi:10.1177/0898264310387132
8.
ChenY.ThompsonE. A. (2010). Understanding factors that influence success of home- and community-based services in keeping older adults in community setting. Journal of Aging and Health, 22, 267-291.
9.
Community Health Data Base: An Information Service of the Public Health Management Corporation. (2008). File documentation for the Community Health Database for 2008 Southeastern Pennsylvania Household Health Survey. http://www.chdbdata.org/householdsurvey.html.
10.
CurtinR.PresserS.SingerE. (2000). The effects of response rate changes on the index of consumer sentiment. Public Opinion Quarterly, 64, 413-428.
11.
DesaiM. M.LentznerH. R.WeeksJ. D. (2001). Unmet need for personal assistance with activities of daily living among older adults. The Gerontologist, 41, 82-89.
12.
DoD. P.FinchB. K.Basurto-DavilaR.BirdC.EscarceJ.LurieN. (2008). Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/white health gap in the United States. Social science & medicine, 67(8), 1258-1268.
13.
EvansG. W.WellsN. M.MochA. (2003). Housing and mental health: A review of the evidence and a methodological and conceptual critique. Journal of social issues, 59(3), 475-500.
14.
FelixH. C.MaysG. P.StewartM. K.CottomsN.OlsonM. (2011). Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Affairs, 30, 1366-1375.
15.
FortinskyR. H.FensterJ. R.JudgeJ. O. (2004). Medicare and Medicaid home health and Medicaid waiver services for dually eligible older adults: Risk factors for use and correlates of expenditure. The Gerontologist, 44, 739-749.
16.
GaskinD. J.PriceA.BrandonD. T.LaVeistT. A. (2009). Segregation and disparities in health services use. Medicare Care Research and Review, 66, 578-589.
17.
GlicksmanA.ClarkK.KlebanM.RingL.HoffmanC. (2014). Building an integrated research/policy-planning age-friendly agenda. Journal of Aging & Social Policy, 26, 131-146.
18.
GrabowskiD. C. (2006). The cost-effectiveness of noninstitutional long-term care services: Review and synthesis of the most recent evidence. Medical Care Research and Review, 63, 3-28. doi:10.1177/1077558705283120
19.
GrovesR. M. (2006). Nonresponse rates and nonresponse bias in household surveys. Public Opinion Quarterly, 70, 646-675.
20.
HaysR. D.RevickiD.CoyneK. S. (2005). Application of structural equation modeling to health outcomes research. Evaluation & the Health Professions, 28(3), 295-309.
21.
HoudeS. C. (1998). Predictors of elders and family caregivers use of formal home services. Research in Nursing & Health, 21, 533-543.
22.
IrwinM.ArtinK.OxmanM. N. (1999). Screening for depression in the older adult: Criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Archives of Internal Medicine, 159, 1701-1704. doi:10.1001/archinte.159.15.1701
23.
IwarssonS.WahlH. W.NygrenC.OswaldF.SixsmithA.SixsmithJ., …TomsoneS. (2007). Importance of the home environment for healthy aging: Conceptual and methodological background of the European ENABLE–AGE Project. The Gerontologist, 47(1), 78-84.
24.
KeeterS.KennedyC.DimockM.BestJ.CraighillP. (2006). Gauging the impact of growing nonresponse on estimates from a national RDD telephone survey. Public Opinion Quarterly, 70, 759-779.
25.
KomisarH. L.FederJ.KasperJ. D. (2005). Unmet long-term care needs: An analysis of Medicare-Medicaid dual eligibles. Inquiry, 42, 171-182.
26.
KroutJ. A. (1985). Service awareness among the elderly. Journal of Gerontological Social Work, 9, 7-19.
27.
McCaslinR. (1988). Reframing research on service use among the elderly: An analysis of recent findings. The Gerontologist, 28, 592-599.
28.
MitchellJ.KroutJ. A. (1998). Discretion and service use among older adults: The behavioural model revisited. The Gerontologist, 38, 159-168.
29.
MoonA.LubbenJ. E.VillaV. (1998). Awareness and utilization of community long-term care services by elderly Korean and non-Hispanic white Americans. The Gerontologist, 38, 309-316.
30.
PathWays PA. (2008). The Elder Economic Security Initiative program: The Elder Economic Security Standard Index for Pennsylvania. Holmes, PA: Author.
31.
PenningM. J. (1995). Health, social support, and the utilization of health services among older adults. Journal of Gerontology: Social Sciences, 50B, 330-339.
32.
RajaS.MaC.YadavP. (2008). Beyond food deserts measuring and mapping racial disparities in neighborhood food environments. Journal of Planning Education and Research, 27(4), 469-482.
33.
SandsP. L.WangY.McCabeP. G.JenningsK.EngC.CovinskyE. K. (2006). Rate of acute care admissions for frail older people living with met unmet activity of daily living needs. Journal of the American Geriatrics Society, 54, 339-344.
34.
SchafftK. A.JensenE. B.HinrichsC. C. (2009). Food deserts and overweight schoolchildren: Evidence from pennsylvania*. Rural Sociology, 74(2), 153-177.
35.
ShapiroA.LohC.MitchellG. (2011). Medicaid cost-savings of home- and community-based service programs for older persons in Florida. Journal of Applied Gerontology, 30, 3-21. doi:10.1177/0733464809348499
36.
ShawM. (2004). Housing and public health. Annu. Rev. Public Health, 25, 397-418.
37.
SilversteinN. (1984). Informing the elderly about public services: The relationship between sources of knowledge and service utilization. The Gerontologist, 24, 37-40.
38.
van BilsenP. M. A.HamersJ. P. H.GrootW.SpreeuwenbergC. (2008). The use of community-based social services by elderly people at risk of institutionalization: An evaluation. Health policy, 87, 285-295.
39.
WalkerR. E.KeaneC. R.BurkeJ. G. (2010). Disparities and access to healthy food in the United States: a review of food deserts literature. Health & place, 16(5), 876-884.
40.
WanT. M. (1982). Use of health services by the elderly in low-income communities. The Milbank Memorial Fund Quarterly: Health and Society, 60(1), 82-107.
