Background: People with intellectual disabilities increasingly live in smaller community settings rather than institutional settings. Home- and community-based services (HCBS) are a type of long-term care in which services and supports are provided in people’s homes and communities. HCBS are essential for people with disabilities to remain in the community.

Method: The 2015-2016 National Core Indicators survey data, along with other datasets, were used to determine how factors impacted service utilization and additional services needed for adults with intellectual and development disabilities (I/DD) in the US. Three groups of factors were used: individual, interpersonal, and public policy factors.

Results: Variables within each of the three groups of factors affected access to HCBS. Of significant note within individual factors, older adults received more services and had fewer additional services needed. Black respondents received fewer services and had more additional services needed. A higher problem behaviors score and use of mobility aids were associated with greater utilization and more additional services needed. Better health was associated with significantly fewer additional services needed. Within interpersonal factors, results indicated that people who lived in group homes received more services than people living in their own or family homes. Additionally, individuals with community jobs received more services. A notable public policy finding indicated people who lived in a state with a Balancing Incentive Program (BIP) got more services but also had additional services needed.

Conclusion: This study examined factors not studied previously and indicates that future research should look at different factors to better understand their impacts on access to HCBS for people with I/DD.

Plain Language Summary

Home and community-based services (HCBS) are a type of long-term services and supports. HCBS are in the community, not in a nursing home or institution. HCBS are important for people with disabilities and chronic health conditions. HCBS allow people to stay in their homes in the community and get support. Our research looked at how different factors changed access to HCBS. Our research is only on people with intellectual and developmental disabilities, or IDD. Access to HCBS included the number of services received. It also included the number of extra services needed. We used a national survey of people with IDD called the National Core Indicators. We also used some other datasets. We wanted to know how three groups of factors affected access to HCBS. These three groups are individual, community, and public policy factors. We found that variables in all three groups affected access to HCBS. Older people got more services and didn't need as many. Black people got fewer services and needed more than White people. People with behaviors and those who used mobility devices got more services. They also needed more services. People who had better health didn't need as many services. Age, race, behaviors, mobility aids, and health are all individual variables. People who lived in group homes got more services than people living in their own or family homes. People who had jobs in the community got more services. Where people lived and if they had a community job were both community variables. People who lived in a state with a program called Balancing Incentive Program, or BIP, got more services but also needed more services. BIP is one of five public policy factors. It's important to learn about this area to make sure people get services they need. More work should happen in this area to add to what we know.

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