Title: Literature Review of Home- and Community-Based Services (HCBS) in Diverse Communities: Utilization

Publication date: November 2023

Overall, minority individuals are less likely than White individuals to use formal services for their home care needs and more likely to rely on family, friends, and other community members as informal caregivers. For those who do receive Medicaid long-term services and supports (LTSS), minority individuals are proportionally much more likely to receive their services via HCBS rather than institutional care compared to White individuals. Among HCBS users, minority groups spend less and have worse levels of self-reported health, while Black HCBS users also have higher rates of hospitalization. There are indications that significant levels of unmet need for HCBS may be present among diverse communities. Barriers to formal service use include lack of awareness of services and how to get them, cultural factors which lead to hesitance to use formal services, and language barriers faced primarily by Hispanic and Asian older adults.