HCBS Framework Domain Definitions
National Quality Forum. (2016). Quality in Home and Services to Support Community Living: Addressing Gaps in Performance Measurement. Washington, DC.
The level of support (e.g., financial, emotional, technical) available to and received by family caregivers or natural supports of individuals who use HCBS.
Access to resources
The level to which the family caregiver/natural support is aware of and able to access resources (e.g., peer support, respite, crisis support, information and referral) that support overall well-being.
Family caregiver/natural support involvement
The level to which family caregivers/natural supports are involved in developing and executing the HCBS consumer’s person-centered care plan in accordance with the preferences of the consumer and family caregiver/natural support. This involvement includes direct assessment of caregiver/natural support needs, not just their ability to provide care, and is an ongoing part of the provision of HCBS.
Family caregiver/natural support wellbeing
The level to which the family caregiver/natural support is assisted in terms of physical, emotional, mental, social, and financial well-being.
Training and skill-building
The level to which the appropriate training and skill-building activities are available to family caregivers/natural supports who desire such activities.
Choice and Control
The level to which individuals who use HCBS, on their own or with support, make life choices, choose their services and supports, and control how those services and supports are delivered.To enable screen reader support, press Ctrl+Alt+Z To learn about keyboard shortcuts, press Ctrl+slash
Choice of services and supports
The level to which individuals who use HCBS have a choice, and are supported in making that choice, in selecting and self-directing their program delivery models, services and supports, provider(s), and setting(s).
Personal choices and goals
The level to which services and plans describe, develop, and support individual choices and life goals.
Personal freedoms and dignity of risk
The level to which individuals who use HCBS have personal freedoms and the ability to take risks.
The level to which individuals who use HCBS, on their own or with support, have decision-making authority over their services and take direct responsibility to manage their services with the assistance of a system of available supports.
The level to which people who use HCBS are integrated into their communities and are socially connected, in accordance with personal preferences.
The level to which individuals who use HCBS have access to employment opportunities that support their needs, choices, and goals.To enable screen reader support, press Ctrl+Alt+Z To learn about keyboard shortcuts, press Ctrl+slash
The level to which individuals who use HCBS engage in desired activities (e.g., employment, education, volunteering, etc.).
Resources and settings to facilitate inclusion
The level to which resources and involvement in community integrated settings are available to individuals who use HCBS.
Social connectedness and relationships
The level to which individuals who use HCBS develop and maintain relationships with others.
The level to which individuals who use HCBS develop and maintain relationships with others.To enable screen reader support, press Ctrl+Alt+Z To learn about keyboard shortcuts, press Ctrl+slash
Consumer Leadership in System Development
The level to which individuals who use HCBS are well supported to actively participate in the design, implementation, and evaluation of the system at all levels.
Evidence of meaningful caregiver involvement
The level to which family caregivers/natural supports of individuals who use HCBS have meaningful involvement in the design, implementation, and evaluation of the HCBS system.
Evidence of meaningful consumer involvement
The level to which individuals who use HCBS have meaningful involvement in the design, implementation, and evaluation of the HCBS system.
System supports meaningful consumer involvement
The level to which the HCBS system facilitates and provides supports for active consumer participation in the design, implementation, and evaluation of the HCBS system.
The level to which HCBS are equitably available to all individuals who need long-term services and supports.
The extent to which a service or support is equitably available to individuals seeking or receiving HCBS.
Equitable access and resource allocation
The extent to which consumers of HCBS have equitable access and ability to obtain needed services and supports (e.g., housing, transportation, employment services) and the extent to which the HCBS system is able to support that access through equitable allocation of resources and minimization of barriers (e.g., environmental, geographic) to access.To enable screen reader support, press Ctrl+Alt+Z To learn about keyboard shortcuts, press Ctrl+slash
Transparency and consistency
The extent to which laws, regulations, and polices are equitably administered and information is publicly available.
Fluctuation of Need
Holistic Health and Functioning
The extent to which all dimensions of holistic health are assessed and supported.
Health promotion and prevention
The level to which the HCBS system focuses on the prevention of adverse health and functional outcomes and promotes the highest levels of health and functioning, across all dimensions of holistic health.
Individual health and functioning
The level to which all aspects of an HCBS consumer’s health and functioning (including physical, emotional, mental, behavioral, cognitive, and social) are assessed and supported.
Human and Legal Rights
The level to which the human and legal rights of individuals who use HCBS are promoted and protected.
Freedom from abuse and neglect
The level to which the HCBS consumer is free from abuse and neglect and the HCBS system implements appropriate prevention and intervention strategies to ensure that the HCBS consumer is free from the threat of harm, actual harm, or disregard of basic needs.
The level to which HCBS consumers, on their own or with support, are provided sufficient, understandable information in order to make decisions.
Optimizing the preservation of legal and human rights
The level to which the HCBS system ensures HCBS consumers are accorded their full legal and human rights and are afforded due process in the delivery of HCBS. The preservation of these rights includes the system’s ability to detect and respond to potential violations in a timely and effective manner.
The level to which the HCBS consumer is able to maintain the desired level of privacy in terms of information sharing, access to private space, and developing and maintaining private relationships.
Supporting individuals in exercising their human and legal rights
The level to which the HCBS system supports individuals in exercising their human and legal rights.
Level of Caregiver Well-Being
The level to which family caregivers/natural supports well-being is assessed.
Person-Centered Planning and Coordination
An approach to assessment, planning, and coordination of services and supports that is focused on the individual's goals, needs preferences, and values. The person directs the development of the plan, which describes the life they want to live in the community. Services and supports are coordinated across providers and systems to carry out the plan and ensure fidelity with the person's expressed goals, needs, preferences, and values.
The level to which the HCBS system and providers support persons in identifying their goals, needs, preferences, and values. This process should gather all of the information needed to inform the person-centered planning process. Re-assessments should occur on a regular basis to assure that changes in consumer goals and needs are captured and appropriate adjustments to services and supports are made.
The level to which the services and supports an individual receives across the healthcare and social service system are complementary, integrated, and fully support the HCBS consumer in meeting his or her needs and achieving his or her goals.
The level to which the planning process is directed by the person, with support as needed, and results in an executable plan for achieving goals and meeting needs that the person deems important. The plan includes the role of the paid and unpaid services and supports needed to reach those goals.
Service Delivery and Effectiveness
The level to which services are provided in a manner consistent with a person's needs, goals, and preferences that help the person to achieve desired outcomes.
The level to which the individuals who use HCBS receive person-centered services and supports. Important aspects of delivery include timely initiation, the degree to which the delivered services and supports correspond with the plan of care, the ongoing assessment of the correlation of delivery and the plan of care, adequacy of the provider network to deliver needed services, and the capacity of the system to meet existing and future demands.
Person's needs met and goals realized
The level to which individuals who use HCBS receive services and supports sufficient to meet their needs and to support them in achieving their goals.
System Performance and Accountability
The extent to which the system operates efficiently, ethically, transparently, and effectively in achieving desired outcomes.
Data management and use
The level to which the system collects data in a manner that is consistent with best practices (i.e., complete, reliable, and valid), makes data publicly available, and uses data for performance improvement.
The level to which services are delivered in a manner that is consistent with the best available evidence.
Financing and service delivery structures
The level to which the system is appropriately financed and has the infrastructure in place to increase the proportion of people served in home and community settings and to meet the needs of consumers.
The adequacy, availability, and appropriateness of the paid HCBS workforce.
Adequately compensated with benefits
The level to which the HCBS workforce is provided compensation, benefits, and opportunities for skill development as a means for ensuring a stable supply of qualified workers to meet the service and support needs of HCBS consumers.
The level to which the workforce is able to deliver services that are aligned with the cultural background, values, and principles of the HCBS consumer (i.e., cultural competency of the workforce) and the level to which the HCBS system trains and supports the workforce in a manner that is aligned with the cultural background, values, and principles of the HCBS workforce (i.e., cultural competency ofthe HCBS system).
Demonstrated competencies when appropriate
The level to which the workforce is able to demonstrate that services are provided in a skilled and competent manner. These skills and competencies are fostered in the workforce through the use of competency-based approaches to training and skill development.
Person-centered approach to services
The level to which the workforce's approach to the delivery of services is tailored to the preferences and values of the consumer. This includes the use of good communication skills to solicit those preferences and values while also demonstrating respect for consumer privacy and boundaries.
Safety of and respect for the worker
The level to which the HCBS delivery system monitors, protects, and supports the safety and well- being of the workforce.
The level to which on-going supports received by individuals who use HCBS are delievered by the same staff members to the extent desired by the recipient.
Sufficient workforce numbers dispersion and availability
The level to which the supply of and the demand for the HCBS workforce are aligned in terms of numbers, geographic dispersion, and availability.
Workforce engagement and participation
The level to which front-line workers and service providers have meaningful involvement in care planning and execution when desired by the consumer; program development and evaluation; and the design, implementation, and evaluation of the HCBS system and policies.