Differential Effects of Home- and Community-Based Services on Functional Outcomes Among Older Adults With Dementia

OBJECTIVES: To examine the differential effects of home- and community-based services (HCBS)-day care, home care, and combined care-on changes in functional outcomes, including activities of daily living dependency, cognitive impairment, and behavioral and psychological symptoms of dementia (BPSD), over 2 years among older adults with dementia. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Eleven thousand five hundred nine grade 5 long-term care (LTC) insurance beneficiaries are diagnosed with dementia in Korea. METHODS: Nationwide LTC Insurance and National Health Insurance data sets between 2017 and 2019 were analyzed. Changes in functional outcomes were assessed at 1- and 2-year follow-ups. HCBS type was categorized as day, home, and combined care. Multiple linear regression analyses were conducted to examine associations between HCBS type and changes in functional outcomes, adjusting for relevant covariates. RESULTS: Individuals receiving home care services experienced significantly less deterioration in cognitive function and fewer BPSD than those receiving day care services at both the 1- and 2-year follow-ups. In contrast, individuals receiving combined care services experienced significantly greater deterioration in activities of daily living dependency, cognitive function, and BPSD than those receiving day care services at both follow-up periods. CONCLUSIONS AND IMPLICATIONS: Individualized home care services and continuity in dementia care may contribute to slower cognitive decline and reduced progression of BPSD. These results highlight the importance of developing HCBS tailored to individuals' cognitive level and care needs and provide evidence to inform the design and refinement of dementia-focused LTC policies.