Community-based services are health and human services delivered where people already live, rather than in hospitals, nursing homes, or other institutions. They cover a wide spectrum: medical care at home, help with daily tasks like bathing and cooking, mental health treatment, transportation, adult day programs, and much more. The common thread is keeping people in their homes and neighborhoods while providing the support they need to live safely and independently.
What Community-Based Services Include
These services generally fall into two broad categories: health services and human services. On the health side, you’ll find skilled nursing visits, physical and occupational therapy, dietary management, hospice care, medication oversight, and durable medical equipment like hospital beds or wheelchairs. On the human services side, the list is longer and more varied: home-delivered meals, adult day care, senior centers, transportation assistance, home repairs and safety modifications, homemaker and chore services, legal help, financial counseling, and telephone check-in programs.
Personal care sits at the center of both categories. This means hands-on help with what professionals call activities of daily living: getting dressed, bathing, using the toilet, eating, and moving between a bed and a chair. A second layer of support covers instrumental activities of daily living, which are the more complex tasks that keep a household running. These include using the phone, shopping, preparing meals, housekeeping, managing medications, handling finances, and arranging transportation.
Who These Services Are Designed For
Community-based services primarily serve people with functional limitations who need regular help with everyday activities. That includes older adults aging in place, people with physical disabilities, individuals with intellectual or developmental disabilities, and those living with chronic mental health conditions. The unifying factor is that without some form of structured support, these individuals would likely need to move into a facility for full-time care.
Eligibility typically depends on a functional assessment rather than just a medical diagnosis. States use standardized tools that evaluate your ability to perform daily activities, your memory and cognition, behavioral and psychosocial needs, sensory function like vision and hearing, and overall health status. The goal of the assessment is to determine whether you meet an institutional “level of care,” meaning your needs are significant enough that you would otherwise qualify for a nursing home or similar facility. If you meet that threshold, you can receive equivalent support at home or in a community setting instead.
Mental Health and Crisis Services
Community-based mental health care operates through a network of community mental health centers that offer outpatient therapy, outreach, day programs, residential support, and crisis intervention. These centers provide a continuum of care, so a person can step up to more intensive services during a crisis and step back down as they stabilize.
Specialty programs address specific situations. Supported employment services (sometimes called Individual Placement and Support) help people with serious mental illness find and keep jobs. First Episode of Psychosis programs provide early, coordinated treatment for young adults experiencing psychosis for the first time. Housing programs assist people transitioning out of homelessness. Crisis centers and rural crisis care programs offer immediate stabilization without requiring a hospital emergency room visit. Certified Community Behavioral Health Clinics are a newer model designed to provide comprehensive, integrated care regardless of a person’s ability to pay.
Respite Care for Family Caregivers
One often-overlooked community-based service is respite care, which gives family caregivers a temporary break while a trained professional steps in. Respite providers help with medications, prepare meals, and offer companionship. The care can happen in your own home, in someone else’s home, at a daycare center (which typically operates up to eight hours on weekdays), or even overnight at a nursing home or hospital for longer breaks.
Respite care isn’t a luxury. Caregiver burnout is a well-documented state of physical and emotional exhaustion that affects caregivers regardless of their dedication. Regular breaks improve a caregiver’s focus, energy, and motivation, which translates directly into better care for the person who depends on them. Planned respite also serves a practical purpose: it lets you test a provider before you ever face an emergency, so you’re not scrambling to find someone trustworthy at the last minute.
How Community-Based Services Are Funded
Medicaid is the largest funder of community-based services in the United States, primarily through Home and Community-Based Services (HCBS) waivers. Under Section 1915(c) of federal law, states can design waiver programs within broad federal guidelines to serve people who prefer long-term care at home rather than in an institution.
These waivers give states significant flexibility. A state can target services to specific regions where the need is greatest or where certain providers are available, rather than offering them statewide. It can limit enrollment to groups at risk of institutionalization. And it can adjust income and resource rules so that people who would only qualify for Medicaid inside an institution can qualify for home-based care instead, even if a spouse or parent’s income would normally disqualify them. This last provision is critical because it prevents families from facing the impossible choice between impoverishing themselves and losing access to care.
Beyond Medicaid, community-based services can also be funded through Medicare (especially home health care), the Older Americans Act (which supports senior centers, meal programs, and caregiver support), state and local programs, Veterans Affairs benefits, and private insurance or out-of-pocket payment.
Cost Compared to Institutional Care
Community-based care costs substantially less than institutional placement. In 2020, Medicaid spent an average of $36,275 per person for those using home and community-based services, compared to $47,279 per person for those in institutional settings like nursing homes. That’s roughly $11,000 less per person per year, according to KFF analysis of Medicaid data.
The savings matter at a systems level because millions of people use long-term services and supports. Medicaid spending per person was nearly nine times higher for people using any form of long-term care ($38,769) than for those who did not ($4,480). Shifting even a portion of the institutional population toward community-based alternatives can free up significant resources. But the cost argument, while compelling, is secondary for most families. The primary draw is that people consistently prefer to stay in their own homes, surrounded by their own communities, for as long as possible.
How to Access Services
The starting point depends on who needs help. For older adults, your local Area Agency on Aging can connect you to available programs and help you navigate eligibility. For people with disabilities, state Medicaid offices administer HCBS waiver programs and can explain what’s available in your area. For mental health services, community mental health centers typically accept walk-ins or referrals and can assess your needs on an intake visit.
Expect a functional assessment as part of the process. A care coordinator or case manager will evaluate your daily living abilities, cognitive function, and health status to determine what level of support you qualify for. From there, services are built around a person-centered plan, meaning the specific mix of help you receive is tailored to your situation, your preferences, and your goals rather than following a one-size-fits-all template. In some states, the assessment also determines an individual service budget, giving you a defined amount of funding to direct toward the services that matter most to you.