Identifying Unmet Needs Driving Disproportionate and Avoidable Nursing Home Placements among Black and Latino Persons Living With Dementia

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PROJECT SUMMARY/ABSTRACT The disproportionate rise in nursing home (NH) use among Black and Latino persons living with dementia (PLWD) reflects the inadequacy of existing programs and policies to support aging in place for the most vulnerable. Enabling aging in the community and preventing avoidable NH placements is widely considered a priority by federal, state, and local entities along with families and older adults. Yet, it is unclear what is needed to support Black and Latino PLWD to remain in the community. While there are many plausible next steps to addressing this poorly understood problem, developing an instrument to identify which unmet needs are disproportionately driving avoidable NH placements is an important actionable step in reducing disparities among Black and Latino PLWD. The objectives of this 5-year proposed project are to 1) develop and test the feasibility, acceptability, reliability, and validity of an assessment instrument aimed at addressing the unmet needs that drive Black and Latino PLWD to experience avoidable NH placements at greater rates than their White counterparts using an exploratory sequential mixed methods research design, and 2) translate preliminary findings onto the public agenda as a policy issue. Aim 1 will use qualitative interviews to describe the unmet needs driving these placements. An integrative analysis of qualitative findings derived from Aim 1 will inform an unmet needs assessment instrument, IN-HOME (Identifying Needs to Help Older adults Maintain Everyday community living), that will be developed, refined and piloted in Aim 2 and psychometrically tested in Aim 3. Preliminary findings from this study will be used to generate actionable, evidence-based policy recommendations to address disparities in NH placements. Aligned with NIA’s strategic priorities to address disparities experienced by minority older adults with Alzheimer’s Disease or Related Dementias (ADRD), this study will form the basis for a subsequent R01 that will tailor IN-HOME for community-dwelling Black and Latino PLWD and investigate which actionable unmet needs place them at greatest risk for NH placements. The candidate, Dr. Jasmine Travers, PhD, MHS, is a gerontological nurse practitioner and assistant professor at New York University (NYU) Rory Meyers College of Nursing. The long-term goal of Dr. Travers is to build an independent research career focused on developing innovative approaches to eliminate disparities in access to and quality of person-centered long term care experienced by Black and Latino PLWD through the use of mixed methods. Under a team of exemplary mentors and scientific advisors with expertise in gerontology, ADRD, mixed-methods, policy, survey design, and psychometric evaluation, Dr. Travers will build on her preliminary work on disparities in access to community long-term care to accomplish training goals in primary research involving vulnerable PLWD, mixed methods, policy, and leadership development. NYU provides an exceptional environment for the completion of the proposed research and for Dr. Travers who has already begun to emerge as a leading disparities researcher in the field of aging and long-term care.