Date of Completion
human development and family studies, aging, minority aging, health services, gerontology
Edna Brown, Ph.D.
Julie Robison, Ph.D.
Idethia S. Harvey, Dr.P.H.
Field of Study
Human Development and Family Studies
Doctor of Philosophy
The purpose of this study was to explore racial differences in home and community-based service (HCBS) use and perceived choice and control in frail elders ages 65 and older participating in the Money Follows the Person (MFP) demonstration program in Connecticut using the Andersen Behavioral Model of Health Service Utilization (1995). The comparison of Black and White program participants provides insight both for clinicians who work directly with frail elders and for researchers who seek to contribute to the gerontological field. This dissertation used secondary data collected from quality of life (QOL) interviews of (N=659) MFP participants who have transitioned from a nursing home into a community-living arrangement. Data from a subsample (n=240) of participants were used to examine whether HCBS contributed to choice and control outcomes, as well to determine the factors that predict HCBS use. Choice and control was measured as choice and control in daily activities and choice and control in service coordination (choice in services; choice in paid help). Multivariate methods were used to predict service use and perceived choice and control. Results show that there are racial differences in choice and control in daily activities and service coordination. Further, functional services (homemaking, companion, and home-delivered meals services) predicted choice and control in daily activities as well as choice in services. Black participants with more Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) limitations were more likely to report choice in services, and Black women were less likely to use functional services. Lastly, among White participants, those receiving services from a live-in aide had lower choice and control in daily living activities, and for Blacks, participants with functional care had higher choice and control scores. Directions for future research are discussed. Study findings provide insight for the future of long term services and supports (LTSS).
Fabius, Chanee Darnell, "Examining Racial Differences among Predictors of Home and Community-Based Service Use and Choice and Control in Older Adults in the Money Follows the Person Program in Connecticut" (2016). Doctoral Dissertations. 1076.