Objective: To understand factors that influence success of home- and community-based services in keeping older adults in community settings, we examined the causal relationships among older adults' personal factors, older adults' home- and community-based services use, and older adults' remaining in communities.
Methods: Structural equation modeling was employed to test a home- and community-based services model based on Andersen's Health Behavioral Model. Data from 5,294 elders in a nationally representative dataset, the Second Longitudinal Study of Aging, were included for analysis.
Results: Two significant supportive factors for older adults to remain in communities were use of paid instrumental activities of daily living (IADL) personal care services and awareness of unmet needs.
Discussion: Our findings suggest the importance of encouraging older adults to acknowledge their unmet needs and to seek community-based support services early, rather than wait until they have developed more serious needs, such as difficulties in activities of daily living (ADL).