Home and Community-Based Service Use, Health Outcomes, and Health Care Costs for People with Alzheimer's Disease and Related Dementias

项目摘要 数以百万计的低收入老年人需要长期服务和支持， 医疗保险和私人保险是有限的，留下医疗补助作为LTSS的主要支付者。为了努力 为了尊重人们对就地养老的偏好并节省成本，州医疗补助计划已经转向 旨在增加家庭和社区服务的使用的政策， 疗养院护理在这种对HCBS的推动下，患有阿尔茨海默病和相关痴呆症的人 （ADRD）有越来越多的机会获得医疗补助HCBS。我们建议调查六氯苯的使用， 结果，以及ADRD患者的医疗保健费用，特别是那些同时拥有医疗保险和 医疗保险。 虽然在过去的几十年里，HCBS的使用在全国范围内有所增加，但各地的HCBS使用率差异很大。 国家，这表明国家政策的潜在重要性，以鼓励使用HCBS。例如， 医疗补助计划对HCBS用户有不同的财务/功能资格和注册上限。但是，在这方面， 关于国家政策的这些要素如何与六氯代苯的使用相关联，人们知之甚少。作为州医疗补助计划 计划努力增加HCBS的使用，需要有强有力的证据来证明不同的州医疗补助计划 政策与ADRD患者使用HCBS相关。 尽管州医疗补助计划推动了HCBS，但这些类型的服务可能并不适合所有人 关于ADRD HCBS的使用可能会满足人们对就地养老的偏好，但随着人们ADRD的进展， 他们可能需要更密集的24小时护理。因此，对这些人使用HCBS可能会导致较低的- 比需要的强度更大的护理，更差的健康结果和更高的医疗保健成本（由于健康状况恶化 成果）。 我们的长期目标是确定州医疗补助HCBS政策的要素， ADRD患者使用HCBS以及评估何时适当使用HCBS以保持他们的安全， 社会各界这项建议有四个目的。首先，我们描述任何使用HCBS，健康结果， （住院、急诊和福尔斯），以及ADRD患者随时间推移的医疗保健费用 （2016-2020年）和全国。其次，我们评估了州医疗补助HCBS政策与任何 在ADRD患者中使用HCBs。第三，我们评估了使用HCBS对健康结果的影响， 不同健康水平的ADRD患者。第四，我们评估使用六氯苯对健康的影响。 不同健康状况的ADRD患者的护理费用。 拟议的研究将提供有关HCBS使用，健康结果和医疗保健的关键信息 ADRD患者的费用。这些知识将有助于告知正在寻求医疗补助的州医疗补助政策制定者， 最有效的方法来解决HCBS，并最终改善ADRD患者的健康结果。

Project Summary Millions of low-income older adults require long-term services and supports (LTSS) but coverage of LTSS by Medicare and private insurance is limited, leaving Medicaid as the primary payer for LTSS. In an effort to respect people's preference for aging in place and to save costs, state Medicaid programs have turned to policies designed to increase the use of home- and community-based services (HCBS), as an alternative to nursing home care. Under this push towards HCBS, people with Alzheimer's disease and related dementias (ADRD) have increasing opportunities to receive Medicaid HCBS. We propose to investigate HCBS use, health outcomes, and health care costs among people with ADRD, particularly those with both Medicare and Medicaid coverage. Although HCBS use has increased nationwide for the past decades, HCBS use rates vary substantially across states, suggesting the potential importance of state policies to encourage HCBS use. For example, state Medicaid programs have different financial/functional eligibility and enrollment caps for HCBS users. However, little is known about how these elements of state policies are associated with HCBS use. As state Medicaid programs strive to increase HCBS use, there is a need for robust evidence about how different state Medicaid policies are associated with HCBS use for people with ADRD. Despite state Medicaid programs' push towards HCBS, these type of services may not be optimal for all people with ADRD. HCBS use may meet people's preference for aging in place, but as people's ADRD progresses, they may need more intensive round-the-clock care. Therefore, HCBS use for these people may lead to lower- intensity care than needed, worse health outcomes, and higher health care costs (as a result of worse health outcomes). Our long-term goal is to identify elements of state Medicaid HCBS policies associated with an increase in HCBS use by people with ADRD as well as to assess when HCBS is appropriately used to keep them safe in the community. This proposal has four aims. First, we describe any use of HCBS, health outcomes (hospitalization, emergency department visits, and falls), and health care costs for people with ADRD over time (2016-2020) and across states. Second, we assess the association of state Medicaid HCBS policies with any use of HCBS among people with ADRD. Third, we assess the effect of HCBS use on health outcomes for people with ADRD across different levels of health status. Fourth, we assess the effect of HCBS use on health care costs for people with ADRD across different levels of health status. The proposed research will provide critical information about HCBS use, health outcomes, and health care costs for people with ADRD. This knowledge will help inform state Medicaid policymakers who are seeking the most effective approach towards HCBS and ultimately improve health outcomes for people with ADRD.