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

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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.