A statewide model for assisting nursing home residents to transition successfully to the community

Darci Buttke, Valerie Cooke, Kathleen Abrahamson, Tetyana Shippee, Heather Davila, Rosalie Kane, Greg Arling

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Minnesota's Return to Community Initiative (RTCI) is a novel, statewide initiative to assist private paying nursing home residents to return to the community and to remain in that setting without converting to Medicaid. The objective of this manuscript is to describe in detail RTCI's development and design, its key operational components, and characteristics of its clients and their care outcomes. Data on client characteristics and outcomes come from the Minimum Data Set, staff assessments of clients and caregivers, and Medicaid eligibility files. Most clients transitioned by the RTCI had entered the nursing facility from a hospital. Clients overwhelmingly wanted to return to the community and fit a health and functional profile making them good candidates for community discharge. Most clients went to a private residence, living alone or with a spouse; yet, adult children were the most frequent caregivers. At one year of follow-up 76% of individuals were alive and living in the community and only a small percentage (8.2%) had converted to Medicaid. The RTCI holds promise as a successful model for states to adopt in assisting individuals who are at risk to become long stay nursing home residents instead to return to the community.

Original languageEnglish (US)
Article number18
JournalGeriatrics (Switzerland)
Volume3
Issue number2
DOIs
StatePublished - Jun 1 2018

Bibliographical note

Funding Information:
This project was supported by grant number R18HS020224 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Publisher Copyright:
© 2018 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

  • Caregiving-Informal
  • Decision making
  • Evaluation

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