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

Abstract

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.

Challenges to community transitions through Money Follows the Person

“…Some states have begun that process, including Connecticut's new My Care Options initiative, which will target people 45‐60 days after admission. Similarly, Minnesota's Return to Community initiative targets private pay nursing home residents at 60‐90 days post‐admission, and its MFP program targets Medicaid‐eligible participants prior to 90‐day eligibility, with promising results.…”

“…Most state‐level transition programs began in the late 1990s . One state‐level example, Minnesota's Return to Community Initiative, transitions non‐Medicaid nursing home residents to their communities, indirectly saving costs by avoiding or delaying Medicaid …”

“…4,6 One state-level example, Minnesota's Return to Community Initiative, transitions non-Medicaid nursing home residents to their communities, indirectly saving costs by avoiding or delaying Medicaid. [7][8][9] The largest transition policy effort is the federal Money Follows the Person (MFP) Rebalancing Demonstration, created under the Deficit Reduction Act of 2005 and expanded by the 2010 Affordable Care Act, which has supported transitions to community living for Medicaid recipients in forty-six states and the District of Columbia. 10 MFP states select one or more "target groups" by age or disability and create protocols to identify participants and develop community HCBS care plans.…”

Patients discharged from higher‐quality skilled nursing facilities spend more days at home

“…With the increasing number of medically complex older adults receiving rehabilitation services in postacute care settings, developing interventions that enhance quality of care and improve outcomes could have considerable public health benefits (eg, improve functional status and independence, reduce utilization of costly acute medical and custodial SNF services). Although limited evidence suggests that care transition interventions may increase discharges to the community 45 or improve post‐SNF discharge outcomes, 46 the vast majority of care transitions interventions has been focused on discharges from the hospital rather than from the SNF 47 . There is little empirical evidence to guide us on how to assist these older adults with the SNF‐to‐home transition.…”

“…8,9,13,44 Awareness of these and other patient-level factors may be of utility in informing discharge planning and identifying which patients are at elevated risk of poor outcomes following discharge to the community. discharges to the community 45 or improve post-SNF discharge outcomes, 46 the vast majority of care transitions interventions has been focused on discharges from the hospital rather than from the SNF. 47 There is little empirical evidence to guide us on how to assist these older adults with the SNF-to-home transition.…”