系统性障碍阻碍了以个人为中心的居家和社区服务（HCBS）：服务使用者和专业人员的观点。

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

作者信息

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

机构信息

Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA.

出版信息

Disabil Health J. 2024 May 28:101629. doi: 10.1016/j.dhjo.2024.101629.

DOI:10.1016/j.dhjo.2024.101629

PMID:38858129

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.

摘要

背景

为响应医疗保险和医疗补助服务中心2014年发布的最终设置规则，基于家庭和社区的服务（HCBS）提供机构加强了以个人为中心（PC）的HCBS规划，以改善参与者对其服务的选择和控制权。尽管呼吁广泛采用PC服务，但系统性障碍影响了服务使用者和专业人员接受和提供PC服务的体验。

目的

本研究描述了HCBS专业人员和使用者对影响PC HCBS服务提供的系统性障碍的看法。

方法

对20名HCBS使用者和22名HCBS专业人员进行半结构化访谈，探讨提供和接受PC HCBS的观点以及提供PC服务面临的更高层面的系统挑战。定性分析聚焦于参与者对系统层面问题的看法。

结果

定性分析产生了三个主题：（1）劳动力考量；（2）资源与服务获取；（3）反馈基础设施。直接服务提供者的高离职率、服务资格确定程序和等候名单影响了服务提供。参与者强调需要提高直接服务提供者的薪酬、获得更高质量的培训、改善财政资源以及建立有效的反馈基础设施。由于新冠疫情公共卫生紧急情况而产生的松绑灵活性使得服务获取得以扩大且质量得以提高。