HCBS refers to services provided in an array of noninstitutional settings. These include
recipients’ homes; community-based group-living arrangements such as congregate housing,
adult foster care, and residential care and assisted living (AL) facilities (the last two terms are
sometimes used interchangeably, but we refer to AL exclusively); and community settings such
as adult day care and adult day health. Services provided via HCBS include care coordination or
case management, personal care assistant service, personal attendant service, homemaker and
personal care agency services, home hospice, home delivered meals, home reconfiguration or
renovation, medication management, skilled nursing, escort services, telephone reassurance
services, emergency help lines, equipment rental and exchange, and transportation. Care through
HCBS also includes educational and supportive group services for consumers or their families.
Some aspects of HCBS are construed as respite care meant to relieve family caregivers. For the
review, AL was examined as a separate subset of HCBS because it encompasses aspects of both
community-based and institutional care.