Author ORCID Identifier
0000-0002-5079-8650
Defense Date
2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Social Work
First Advisor
Kyeongmo Kim
Abstract
As the U.S. witnesses a rapid increase in its older adult population, the demand for Home and Community Based Services (HCBS) is on the rise. However, older adults can experience significant disparities in service availability due to the different neighborhood characteristics such as socio-economic and demographic status. Research on HCBS's impact remains fragmented, and policies surrounding it vary from state to state. To address this gap, a comprehensive study in Virginia delved into the relationship between neighborhood characteristics, HCBS, and older adults' health through a scoping review and two quantitative analyses.
The scoping review revealed that HCBS improved health outcomes in general and reduced hospitalization rates. Yet, disparities persisted, with Black and Asian older adults experiencing limited access to HCBS compared to their White counterparts. Additionally, neighborhoods with lower HCBS availability correlated with poorer health outcomes. The spatial analysis further illuminated these disparities, showing a positive correlation between population density and HCBS availability in most areas. However, regions like Southside Virginia suffered from lower HCBS availability despite a significant older adult population. A multilevel mediation model underscored the indirect impact of neighborhood characteristics, especially rurality, unemployment, and the proportion of older adults, on older adults' health via HCBS availability, emphasizing the need for tailored services addressing demographic disparities.
To bridge these gaps, policymakers must prioritize equitable allocation of HCBS resources, considering demographic nuances within communities. By addressing these disparities, Virginia can enhance the health outcomes of its aging population, fostering well-being across diverse communities.
Rights
© Seon Kim
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-9-2024