Long-Term Outcomes of a Home- and Community-Based Services Program: Competing Risk Models

Purpose: The purpose of this study is to investigate the incidence of all-cause mortality, institutionalization, and condition improvement among participants of a state home- and communitybased services program (HCBS). Methods: We evaluated the follow-up data of 11,444 individuals with disabilities aged 45-59 years at application who received services from the HCBS program from the state of Illinois. Statistical analysis was conducted using the cause-specific hazard and the subdistribution hazard regression models. Results: In all, 4,900 (42.8%) individuals died, 1,005 (8.8%) were institutionalized, and 1,980 (17.3%) improved at service closure. Males of older age, living with others, with a medical referral, a general physical debilitation, and receiving more service hours increased the risk of allcause mortality. Middle-aged women with a physical orthopedic disability and a low number of service hours showed greater improvement. Conclusions: The risk of the outcomes was related to baseline characteristics, types of disabilities, and service factors. We also observed that demographic factors such as gender, race, and living arrangements affected the risks of the outcomes.