'Can't always get what you want': Allocation of community-based services for older adults

Background: When older adults seek support through formal community-based services, they or their family caregivers have determined a need for assistance with ongoing functional needs. Eligibility for long-term services and supports is often based on clinically evaluated need determined by a professional clinical health assessment. Methods: Using state agency data, we explored the relationship between clinically evaluated functional needs and the likelihood of receiving services to address specific needs among 1322 adults aged 60+ requesting assistance through Virginia's Area Agencies on Aging in 2014-2015. Results: Most older adults (77.4%) received at least one service. Older adults who received at least one service tended to have fewer personal activities of daily living needs [t(1298)=2.716, p = 0.007] and instrumental activities of daily living needs [t(1298)=2.900, p = 0.004)] than older adults who did not receive any services. Few clinically evaluated functional needs were significantly associated with the older adults receiving services explicitly aligned with their limitations. Conclusions: Findings raise questions about service allocation and alignment of needs. A large body of research documents how receiving insufficient help is associated with adverse health consequences; it is a serious public health concern for older adults. We recommend aging services organizations assess their approach to service allocation to ensure evaluated need better aligns with service receipt.