The Multilevel Mediation Effect of Hcbs between Neighborhood Characteristics and Older Virginian's Self-Rated Health

Background: The demand for Home and Community-Based Services (HCBS) is increasing as the older adult population grows rapidly. HCBS is known to enhance the health and well-being of older adults. However, older adults can experience significant disparities in service availability due to various neighborhood characteristics, such as socioeconomic and demographic status. Previous literature has indicated a relationship between neighborhood characteristics, HCBS, and older adults’ health. Still, simultaneous identification is rare, and very few studies focus on older Virginians and HCBS. Therefore, this study examines the relationship between neighborhood characteristics, HCBS, and older adults' self-rated health (SRH) in Virginia.

Method: This study merged three datasets using zip codes: 1) 2021 Behavioral Risk Factor Surveillance System, 2) 2022 County Health Rankings Virginia Data, and 3) data collected from Senior Navigator, a search engine for local resources for older adults. The sample included 3,406 older adults aged over 65 years. To measure neighborhood characteristics, this study included socioeconomic status (i.e., income inequality, unemployment rate, median household income), demographic status (i.e., population size, percentage of older adults, percentage of racial groups), and rurality. The number of HCBS agencies was measured as HCBS availability. SRH was measured using a 5-point Likert scale (0 = poor, 5 = excellent). Descriptive, bivariate statistics and a multi-level mediation model were used for the analysis.

Results: Correlation tests revealed that all neighborhood characteristics correlated with HCBS availability and older adults’ SRH. The results of the multi-level mediation model indicated that rurality (β = -0.02, p = 0.021), unemployment (β = 0.11, p = 0.007), and the proportion of older adults (β = -0.03, p = 0.033) had an indirect effect on older adults' health, with HCBS availability mediating the relationship. Among these variables, only the unemployment rate directly affected (β = -0.27, p = 0.010) the health of older adults in Virginia.

Conclusion: This study highlights the importance of neighborhood characteristics and HCBS availability on older adults’ health. Policy implications should focus on expanding the availability of HCBS considering neighborhood characteristics, especially rurality, unemployment rate, and the proportion of older adults. These efforts are crucial for meeting the service needs of older Virginians and enhancing their health across diverse Virginia communities.