We frequently discuss the desire of many older adults to stay in their homes as they age, a goal often called “aging in place.” Along with that desire come challenges: availability of paid or unpaid caregivers, health and safety concerns, social isolation, and anxiety. Cost, however, is almost always near the top of the list. A recent survey on access to home- and community-based services (HCBS) sheds useful light on how providers are responding to these issues.
What are home- and community-based services?
Home- and community-based services (HCBS) encompass a range of supports designed to help older adults and people with disabilities live independently in their homes or communities rather than in institutional settings like assisted living communities, nursing homes, or hospitals.
HCBS are typically tailored to an individual’s needs and may include:
- Assistance with activities of daily living (ADLs) such as bathing, dressing, meal preparation, and medication management
- Respite care for family caregivers
- Home modifications to improve safety and accessibility
- Transportation assistance for medical appointments or social activities
- Case management to coordinate care
- Therapeutic services like physical or occupational therapy
- Support for managing chronic conditions
These services support autonomy and can improve quality of life by allowing older adults to preserve relationships, routines, and familiar environments—factors that are important for emotional and mental well-being. HCBS also help reduce the demand for institutional care, which is often more expensive and can be disruptive for older adults who must relocate.
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Meeting care goals and preferences
HCBS have become increasingly prominent in long-term care policy as more people prefer aging in place and community-based care. This trend aligns with a shift in senior living toward person-centered care, which prioritizes an individual’s preferences, values, and goals when planning services.
Retirement communities—especially continuing care retirement communities (CCRCs or life plan communities)—are expanding HCBS offerings to meet resident needs and serve surrounding communities. To better understand the current HCBS landscape, a Chicago-based specialty investment bank that serves healthcare and senior living sectors conducted a CFO Hotline Survey in November to gather feedback from senior living CFOs about HCBS.
>> Related: Remain in the Home You Love: The Continuing Care at Home Model
The home- and community-based services landscape
Nearly 200 organizations took part in the survey, with about 120 reporting they offer HCBS. Most respondents came from single-site not-for-profit CCRC/life plan community organizations (53.6%), and roughly 30% represented multisite providers within a single state. Key findings included:
- Over 60% of respondents confirmed their organizations provide HCBS. Specific services included:
- 68.6% home care
- 43% home health
- 32% hospice
- 21.9% continuing care at home (CCaH or “CCRC without walls”)
- 11.7% adult day care
- The highest concentration of HCBS providers was in the South (57%), followed by the West (18%), Midwest (15%), and Northeast (10%). Pennsylvania led the states in HCBS participation.
- Single-site CCRC/life plan communities accounted for 47.9% of HCBS offerings, with multisite/same-state providers at 38.5%.
- Among HCBS providers, 34.4% have offered such services for more than 15 years, while 46.8% have provided them for 10 years or less.
- Of providers not currently offering HCBS, 68% reported no plans to do so. However, about 30% said they do plan to add HCBS, and half of those expect to begin within 24 months.
>> Related: A Break for Family Caregivers: Adult Day Care and Other Respite Care Options
Options to address older adults’ financial constraints
The survey also explored where, how, and why senior living communities deliver HCBS.
Where: Most organizations (85.5%) provide HCBS on-site at their retirement community, 71.8% offer in-home care, and 20% deliver services to local nursing centers.
How: An array of healthcare professionals and caregivers deliver HCBS, but the majority (86.3%) rely on their own nursing and care staff.
Why: The primary reasons cited were growing demand for HCBS (79.7%), aligning services with organizational mission (70.7%), and complementing current offerings (69.9%). Revenue diversification (54.5%) and community outreach (44.7%) were also important factors.
Some respondents noted an additional motivation: using HCBS to support assisted living residents who have exhausted financial resources and can no longer afford on-site long-term care (18.7%). This highlights an important role HCBS can play for middle-market older adults who lack the funds to move into a retirement community or who run out of resources while receiving care. HCBS can often be a more affordable option that allows people to remain at home without immediately needing to qualify for Medicaid.
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The more care options, the better for everyone
Every senior living and care option has trade-offs—cost, quality, location, and individual needs all factor into the right choice. That is true for HCBS as well: when a higher level of care is required than can be safely provided at home, relocation to assisted living, a nursing home, or a hospital may still be necessary.
Nevertheless, the survey shows more senior living communities are developing innovative alternatives to traditional on-site care, with HCBS emerging as a preferred solution. By offering these services, retirement communities can help seniors remain healthy and independent as long as possible while meeting care needs, respecting personal preferences, and acknowledging budget constraints.
Financially, HCBS programs vary in scale: 69% of survey respondents reported HCBS revenue under $10 million, while 30% generated over $10 million, and 6.9% reported more than $100 million. As HCBS programs expand in number and scope, they can offer meaningful benefits to both providers and older adults seeking affordable, person-centered care options.