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、持续时间更长的热浪，人们与之生活在一起 痴呆症(PLWD)特别容易患上。该项目旨在评估医疗补助计划的家庭-和 以社区为基础的服务(HCBS)和相关的国家政策可以缓解高温的负面影响 在PLWD之间的波浪。家庭护理服务包括在个人家中提供的长期护理服务(即 以个人护理访问等为基础的服务)或成人寄养家庭等有执照的社区设施和 辅助生活设施(即基于社区的服务)。如果PLWD在炎热期间接受个人护理访问 海浪，个人护理人员可以帮助确保家里有足够的降温和通风，提供 给饮料降温，监测补水水平。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。这些设施通常有集中冷却系统；工作人员可以监控 改善居民的水分水平，控制与高温相关的疾病症状。然而，关于室内的政策 获得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对 热浪。 该项目将扩大父母赠款的覆盖范围，评估可持续发展的六氯联苯的使用、健康结果、 以及医疗保健成本及其与国家政策的关联。以现有的联邦医疗保险和医疗补助为基础 索赔数据库和来自父母赠款的背景知识，我们将实现三个目标：1)评估 热浪对健康服务利用和健康结局的影响，分别针对使用居家服务的PLWD 2)评估接受家访的缓和效果 在热浪期间，与热浪相关的卫生服务使用情况和接受PLWD患者的健康结果 以家庭为基础的服务，以及3)评估国家法规(关于#年的温度控制)的缓和效果 获得许可的社区设施)，以了解与热浪相关的卫生服务使用情况和可持续发展人群的健康状况 接受以社区为基础的服务。 我们的提案针对气候变化和健康倡议的健康公平支柱，重点是 使用医疗补助HCBS的PLWD。PLWD的这一亚群更有可能独自生活，生活在极端的 贫穷，健康状况一般/较差，所有这些都加剧了极端高温的挑战，并使它们 极易受到其负面影响的影响。拟议的研究将产生可行的建议，以 减轻热浪对PLWD高危人群的不利影响，并确保我们建立 保护这些人口免受气候变化不断升级的影响的措施。

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.