Moderating effects of Medicaid long-term care services on heat wave-associated outcomes among people living with dementia

项目摘要 气候变化造成了更频繁、更强烈、更持久的热浪， 老年痴呆症（PLWD）是特别脆弱的。该项目旨在评估医疗补助的家庭和 基于社区的服务（HCBS）和相关的国家政策可以减轻热的负面影响 在PLWD中的波浪。HCBS包括在个人家中提供的长期护理服务（即，家- 基于服务，如个人护理访问）或在有执照的社区设施，如成人寄养家庭， 辅助生活设施（即，社区服务）。如果PLWD在高温期间接受个人护理 波浪，个人护理人员可以帮助确保家庭充分冷却和通风， 清凉饮料和监测水化水平。同样，在热浪期间生活在有执照的社区环境中， 可以为PLWD提供优势。这些设施通常有中央冷却系统;工作人员可以监控 居民的水化水平和管理与热有关的疾病症状。然而，关于室内的政策 许可的社区设施的气候控制因州而异，可能会影响每个设施的准备工作， 热浪 该项目将扩大父母补助金的范围，评估艾滋病患者的HCBS使用情况、健康结果， 以及医疗成本和国家政策的关系。建立在现有的医疗保险和医疗补助的基础上 索赔数据库和背景知识从父母赠款，我们将实现三个目标：1）评估 热浪对卫生服务使用和健康结果的影响，分别针对使用家庭为基础的PLWD 服务和谁使用社区为基础的服务，2）评估接受家访的调节作用 在热浪期间，接受艾滋病毒/艾滋病治疗的人中， 以家庭为基础的服务，以及3）评估国家法规的调节作用（对温度控制， 持牌社区设施）对热浪相关的卫生服务使用和健康结果的PLWD 接受社区服务。 我们的提案涉及气候变化和健康倡议的健康公平支柱，重点是 使用Medicaid HCBS的PLWD。这类艾滋病患者更有可能独居，生活在极端恶劣的环境中， 贫困，经历公平/健康状况不佳，所有这些都加剧了极端高温的挑战，使他们 很容易受到其负面影响。拟议的研究将产生可操作的建议， 减轻热浪对这一高危人群的不利影响，并确保我们建立 采取措施保护这一群体免受气候变化不断升级的影响。

Project Summary Climate change has created more frequent, intense, and longer-lasting heat waves, to which people living with dementia (PLWD) are particularly vulnerable. This project aims to evaluate whether Medicaid's home- and community-based services (HCBS) and relevant state policies could mitigate the negative effects of heat waves among PLWD. HCBS includes long-term care services provided in an individual's home (i.e., home- based services such as personal care visits) or in licensed community facilities such as adult foster homes and assisted living facilities (i.e., community-based services). If PLWD receive personal care visits during heat waves, personal care workers may help ensure that the home is adequately cooled and ventilated, provide cool drinks, and monitor hydration levels. Similarly, living in a licensed community setting during heat waves can offer advantages for PLWD. These facilities often have centralized cooling systems; staff can monitor residents' hydration levels and manage heat-related illness symptoms. However, policies regarding indoor climate control for licensed community facilities vary by state and may affect each facility's preparedness for heat waves. This project will extend the reach of the parent grant, which assesses PLWD's HCBS use, health outcomes, and healthcare costs and their association with state policies. Building upon existing Medicare and Medicaid claim databases and contextual knowledge from the parent grant, we will accomplish three aims: 1) Assess the effect of heat waves on health service use and health outcomes, separately for PLWD who used home-based services and who used community-based services, 2) Assess the moderating effect of receiving home visits during heat waves on heat wave-associated health service use and health outcomes among PLWD receiving home-based services, and 3) Assess the moderating effect of state regulations (on temperature control for licensed community facilities) on heat wave-associated health service use and health outcomes among PLWD receiving community-based services. Our proposal addresses the health equity pillar of the Climate Change and Health Initiative by focusing on PLWD who use Medicaid HCBS. This sub-group of PLWD is more likely to live alone, live under extreme poverty, and experience fair/poor health, all of which exacerbate the challenge of extreme heat and make them highly susceptible to its negative effects. The proposed research will generate actionable recommendations to mitigate the adverse effects of heat waves on this high-risk group of PLWD and ensure that we establish measures to safeguard this population from the escalating impacts of climate change.