Date of Completion


Embargo Period



human development and family studies, aging, minority aging, health services, gerontology

Major Advisor

Edna Brown, Ph.D.

Associate Advisor

Julie Robison, Ph.D.

Associate Advisor

Idethia S. Harvey, Dr.P.H.

Field of Study

Human Development and Family Studies


Doctor of Philosophy

Open Access

Open Access


The purpose of this study was to explore racial differences in home and community-based service (HCBS) use and perceived choice and control in frail elders ages 65 and older participating in the Money Follows the Person (MFP) demonstration program in Connecticut using the Andersen Behavioral Model of Health Service Utilization (1995). The comparison of Black and White program participants provides insight both for clinicians who work directly with frail elders and for researchers who seek to contribute to the gerontological field. This dissertation used secondary data collected from quality of life (QOL) interviews of (N=659) MFP participants who have transitioned from a nursing home into a community-living arrangement. Data from a subsample (n=240) of participants were used to examine whether HCBS contributed to choice and control outcomes, as well to determine the factors that predict HCBS use. Choice and control was measured as choice and control in daily activities and choice and control in service coordination (choice in services; choice in paid help). Multivariate methods were used to predict service use and perceived choice and control. Results show that there are racial differences in choice and control in daily activities and service coordination. Further, functional services (homemaking, companion, and home-delivered meals services) predicted choice and control in daily activities as well as choice in services. Black participants with more Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) limitations were more likely to report choice in services, and Black women were less likely to use functional services. Lastly, among White participants, those receiving services from a live-in aide had lower choice and control in daily living activities, and for Blacks, participants with functional care had higher choice and control scores. Directions for future research are discussed. Study findings provide insight for the future of long term services and supports (LTSS).