Increasing successful returns to community living from nursing facilities through the Money Follows the Person program: Mechanisms for reducing disparities for older adults with dementia

大多数患有阿尔茨海默病和阿尔茨海默病相关痴呆(PLWD)的人更喜欢呆在社区的家里，然而研究表明，他们比没有阿尔茨海默病和阿尔茨海默病相关痴呆(AD/ADRD)的人更不可能在护理机构住宿后成功重返社区。医疗补助的资金跟随个人(MFP)计划成功地帮助超过10万人在护理机构住宿后重返社区生活，康涅狄格州是40多个参与州中参与率最高的州之一。研究发现，PLWD减少了获得MFP计划的机会，成功搬出护理设施的几率更低，但尚不清楚是什么机制导致了这些差异。这项研究询问了为什么存在这些差距，以及是什么导致了这些差距，以确定改善可持续发展的公平的政策杠杆。我们还将按种族和民族分析差异，依据的证据是，在康涅狄格州，非西班牙裔黑人和西班牙裔MFP参与者比非西班牙裔白人参与者更有可能完成重返社区的行动。使用混合方法，我们将确定影响三个不同结果的个人、家庭、组织和社区因素：向MFP计划提交的申请，完成从护理机构到社区之家的搬迁，以及持续的社区生活。这项研究的三个目标包括：目标1：对患有和不患有AD/ADRD的个人及其非正式照顾者进行深入访谈，以确定他们参与MFP并取得成功的障碍和促进者；目标2：询问参与MFP计划每一步的工作人员有关导致PLWD不同经历的机制和潜在的改变杠杆；以及目标3：通过对大约55,000名康涅狄格州医疗补助护理机构居民的定量分析，确定个人健康、家庭支持和组织实践等机制如何导致MFP应用、已完成的搬迁和持续的社区生活。这项研究建立在我们团队作为该州MFP计划评估者的14年的基础上，我们与康涅狄格州社会服务部(州医疗补助管理人)的长期关系，后者热衷于改善MFP对这一人群的健康公平。该研究还利用了由我们的团队收集且唯一可访问的丰富MFP数据，并将其与Medicaid和Medicare索赔数据以及最低数据集(MDS)数据合并，以创建用于分析MFP结果的强大分析数据集。这项研究在三个结果的概念化方面具有创新性，这些结果代表了MFP过程连续体中出现差异的不同潜在点，利用了关于MFP计划和参与者的丰富且独特的数据，以及我们的州政策合作伙伴承诺的学术-政府研究伙伴关系，后者准备修改康涅狄格州的MFP计划，以改善PLWD的健康公平。

Most people living with Alzheimer’s disease and Alzheimer’s disease-related dementias (PLWD) prefer to remain at home in the community, yet research shows that they are less likely than people without Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) to successfully return to the community following nursing facility stays. Medicaid’s Money Follows the Person (MFP) program has successfully helped over 100,000 individuals return to community living after nursing facility stays, and Connecticut has one of the highest rates of participation among over 40 participating states. Research finds PLWD have decreased access to the MFP program and lower odds of successfully moving out of nursing facilities, yet it is unknown what mechanisms are leading to these disparities. This study asks why these disparities exist and what is causing them in order to identify policy levers to improve equity for PLWD. We will also analyze differences by race and ethnicity, based on evidence that in Connecticut non-Hispanic Black and Hispanic MFP participants are more likely than non-Hispanic White participants to complete moves back to the community. Using a mixed-methods approach we will identify individual, family, organizational, and community factors which influence three distinct outcomes: applications submitted to the MFP program, completed moves from nursing facility to community homes, and sustained community living. The study’s three aims include: Aim 1: in-depth interviews with individuals with and without AD/ADRD and their informal caregivers to identify barriers and facilitators of their participation and success in MFP; Aim 2: asking staff involved in each step of the MFP program about mechanisms contributing to different experiences for PLWD and potential levers for change; and Aim 3: identifying how mechanisms such as individual health, family support, and organizational practices contribute to disparities in MFP applications, completed moves, and sustained community living through quantitative analysis of approximately 55,000 Connecticut Medicaid nursing facility residents. This study builds upon our team’s 14+ years as the evaluator of the state’s MFP program, our long-standing relationship with Connecticut’s Department of Social Services (the state Medicaid administrator) which is enthusiastic about improving health equity in MFP for this population. The study also leverages a constellation of rich MFP data collected by and uniquely accessible to our team and merges it with Medicaid and Medicare claims data and Minimum Data Set (MDS) data to create a powerful analytic dataset for analyzing MFP outcomes. The study is innovative in conceptualization of three outcomes representing different potential points where disparities emerge along the MFP process continuum, taking advantage of rich untapped and unique data on the MFP program and participants, and an academic-government research partnership with a commitment from our state policy partner who is ready to modify Connecticut’s MFP program to improve health equity for PLWD.