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Table 2 Practice Operations: Identifying and Assessing Social Needs

From: Home and community-based services coordination for homebound older adults in home-based primary care

Survey Question N N%
Does your practice assess patient needs for HCBS?
 Yes 98 98%
 No 1 1%
 Unknown 1 1%
How are patient needs for HCBS assessed? (Select all that apply)
 Periodic ongoing reassessments 86 88%
 Initial intake assessment 76 78%
 Other 12 12%
Are HCBS needs documented in the care plan?
 Yes 86 88%
 No 9 9%
 Unknown 3 3%
What typically initiates a referral for HCBS?
 Healthcare provider recommendation / observation 63 64%
 Caregiver request 12 12%
 Social worker recommendation / observation 8 8%
 Patient request 6 6%
 Other 9 9%
How many of your patients or caregivers had HCBS needs (past 12 months)
 Most/All 73 74%
 None/Few/Some 25 26%
What were the most common service needs? (Select all that apply) (Top 5 listed)
 Personal care (e.g., bathing, toileting, etc.) 82 84%
 Medication adherence 39 40%
 Caregiver supports / training 37 38%
 Case management 35 36%
 Transportation 31 32%