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症（PLWD）的人更喜欢留在社区的家中，但研究表明，他们不太可能比没有阿尔茨海默病和阿尔茨海默病相关痴呆症（AD/ADRD）的人在护理设施停留后成功返回社区。医疗补助的钱跟着人走（MFP）计划已成功帮助超过10万人在护理设施停留后返回社区生活，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，并且成功搬出护理设施的几率较低，但尚不清楚是什么机制导致了这些差异。这项研究探讨了为什么存在这些差异，是什么造成了这些差异，以便确定改善艾滋病毒/艾滋病患者公平待遇的政策杠杆。我们还将分析种族和民族的差异，根据证据表明，在康涅狄格州的非西班牙裔黑人和西班牙裔MFP参与者比非西班牙裔白色参与者更有可能完成搬回社区。使用混合方法的方法，我们将确定个人，家庭，组织和社区因素，影响三个不同的结果：申请提交给MFP计划，完成移动从护理设施到社区家园，并持续的社区生活。该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，以确定他们参与和成功参与MFP的障碍和促进因素;目标2：询问参与MFP计划每个步骤的工作人员，了解有助于PLWD不同体验的机制和潜在的变革杠杆;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申请、完成的搬迁和持续的社区生活的差异。这项研究建立在我们的团队的14年以上的国家的MFP计划的评估，我们与康涅狄格州的社会服务部（国家医疗补助管理员）的长期关系，这是积极改善健康公平MFP为这一人群。该研究还利用了我们团队收集的丰富MFP数据，并将其与医疗补助和医疗保险索赔数据以及最小数据集（MDS）数据合并，以创建一个强大的分析数据集，用于分析MFP结果。这项研究是创新的概念化的三个结果代表不同的潜在点出现的差异沿着MFP过程连续体，利用丰富的未开发的和独特的数据的MFP程序和参与者，和学术-政府研究伙伴关系的承诺，从我们的国家政策合作伙伴谁是准备修改康涅狄格州的MFP程序，以提高健康公平的PLWD。

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.