May 28, 2019

Older adults can be safely discharged from nursing homes if proper networks are in place

Hass Minnesota A new study from Purdue University shows that well-managed and networked resources can make a difference in returning people home safely. (Damir Bosnjak/Unsplash) Download image

WEST LAFAYETTE, Ind. — It could be your grandmother who fell and broke her hip and is in a nursing home receiving therapy to get her balance and strength back. Or it could be your father who became ill, but was well enough to be discharged from the hospital, but not well enough to go back home.

Both have the desire to go home, but it can be a challenge. A new study by researchers at Purdue University, University of Minnesota and Harvard Medical School reviewing the state of Minnesota’s Return to Community Initiative (RTCI) shows that well-managed and networked resources can make a difference in returning people home safely.

The study, published in Health Services Research, shows that an estimated 11% of nursing home residents assisted by RTCI would have become permanent nursing home residents if not for the program. It also showed an annual savings of about $3.9 million over a four-year period. The annual budget was $3.5 million for the services across Minnesota.

 “We found that over a four-year period that this program, at best, breaks even and even has a small amount of savings for the state,” says Zachary Hass, an assistant professor at Purdue University’s schools of Nursing and Industrial Engineering, core faculty for the Regenstrief Center for Healthcare Engineering at Purdue, and lead author of the study. “It is at least paying for itself.”

Which is good news for state governments, taxpayers, health care providers, and most importantly, the people who want to go home.

Minnesota is nationally known for its network of care for older adults. The state is divided into six regions of area agencies on aging, who work with 382 participating nursing homes on the RTCI program. 

The RTCI program provides care in appropriate settings. In the case of Minnesota, RTCI works with non-Medicaid residents, or residents on Medicare or private-pay insurance. This study is one of the first to use a targeting method with non-Medicaid population data. Most studies are currently based on Medicaid’s Money Follows the Person program.

The team reviewed the data of 18,488 Minnesota nursing home residents who were admitted between April 2014 and December 2016, were non-Medicaid at admission and remained in the nursing home for at least 45 days.

“The expectation is that they will be back home. The longer they stay, the more likely they won’t go home,” Hass said.

In the study, researchers discovered there is no urban-rural divide in the quality of care. The resources are there; residents just might have to go a further distance. “Minnesota has numerous resources, which helps facilitate community discharges,” Hass said.

“RTCI facilitates discussion between the nursing home, home- and community-based service providers, families and the person needing the care to come up with a person-centered plan for living at home,” said Kari Benson, executive director for the Minnesota Board on Aging. “It helps people know they have a choice, and that we as a state are listening and want them to be successful at home. This is not only a state goal but a national focus as well.”

Minnesota’s nursing homes see the benefit of working together with families and other providers to make transitions easier, reduce admissions and provide resources for families including a video series, Benson said.

 “Nursing homes don’t want to see their residents back in the hospital or emergency room, so this partnership ensures that the resident is as prepared as possible to start managing their own care at home,” Benson said.

Follow-up calls to participants are made following discharge from a facility after 3, 10, 30 and 90 days and every 90 days after that. “People like being checked on,” Hass said. “You get to return home. Many people prefer to be at home to live out their days.”

The work aligns with Purdue's Giant Leaps celebration, acknowledging the university’s global advancements made in health, longevity and quality of life as part of Purdue’s 150th anniversary. This is one of the four themes of the yearlong celebration’s Ideas Festival, designed to showcase Purdue as an intellectual center solving real-world issues.

This study was supported by grant number R18HS020224 from the Agency for Healthcare Research and Quality and in collaboration with the Minnesota Department of Human Services

Writer: Matthew Oates, 765-496-2571, oatesw@purdue.edu, @mo_oates 

Sources: Zachary Hass, 765-494-4020, zhass@purdue.edu

Kari Benson, Minnesota Department of Human Services. For media inquiries with Benson, please contact Sarah Berg, media relations manager for Minnesota Department of Human Services, at sarah.berg@state.mn.us.

Note to Journalists:  For a copy of the study, please contact Matthew Oates of the Purdue University News Service at 765-496-2571 or oatesw@purdue.edu.


ABSTRACT

Assessing the impact of Minnesota’s return to community initiative for newly admitted nursing home residents

Zachary Hass, Mark Woodhouse, David C. Grabowski, Greg Arling

Objective: To evaluate Minnesota's Return to Community Initiative's (RTCI) impact on community discharges from nursing homes.

Data Sources: Secondary data were from the Minimum Data Set and RTCI staff (April 2014  –  December  2016). The sample consisted of 18,444 non-Medicaid nursing home admissions in Minnesota remaining for at least 45 days, with high predicted probability of community discharge.

Study Design: The RTCI facilitates community discharge for non-Medicaid nursing home residents by assisting with discharge planning, transitioning to the community, and postdischarge follow-up. A key evaluation question is how many of those transitions were directly attributable to the program. Return to Community Initiative was implemented statewide without a control  group. Program impact was measured using regression discontinuity, a quasi-experimental design approach that leverages the programs targeting model.

Principal Findings: Return to Community Initiative increased community discharge rates by an estimated 11 percent (P < 0.05) for the targeted population. The program effect was robust to time and increased with level of facility participation in RTCI.

Conclusions: The RTCI had a modest yet significant impact on the community discharge rates for its targeted population. Findings have been applied in strengthening the RTCI's targeting approach and transitioning process.


 

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