Factors Impacting Access to Home and Community-Based Services for People with Intellectual Disabilities

Objective: The aim of this dissertation is to understand which factors are associated with service utilization and additional services needed for home and community-based services overall and within the home for people with intellectual disabilities (ID). Background: People with ID are living in smaller community settings versus larger institutional settings at higher rates each year with the provision of services and supports within the community. These supports are essential in accessing and remaining in the community. Conceptual Framework: Andersen’s Behavioral Model uses a three-pronged approach in understanding service utilization by examining the impact of predisposing, need, and enabling factors. Predisposing factors are demographic characteristics of an individual. Need factors are factors that impact how needed a service is. Enabling factors are “conditions” that allow an individual to meet a need for a service. This dissertation applies a revised understanding of Andersen’s Behavioral Model to determine which factors are associated with home and community-based service utilization and additional services needed. Methods: This research uses secondary data from the National Core Indicators 2015-2016 Adult Consumer Survey. Descriptive statistics were calculated for the independent and outcome variables. Negative binomial regressions were used to determine which factors impacted service utilization and additional services needed. Binary multivariable logistic regression were utilized to determine which factors were associated with received home services, additional home services needed, and receipt of 24-hour paid home support. Results: Notable findings of this research show that minorities fared worse across the outcomes compared to their White counterparts. Older adults had more access to services and less additional services needed. Enabling factors, such as the Balancing Incentive Program and community fiscal effort for IDD services, produced mixed results on outcomes. Need factors such as problem behaviors, level of intellectual disability, and mobility aids were often associated with more services received but also additional services needed. Conclusion: Future research should include enabling factors such as Balancing Incentive Program, waitlists, and institutions that previous research has not considered. Additionally, future research should look at overall services and also specific services, to determine if specific services drive differences within overall services.