Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;3(2):18.
doi: 10.3390/geriatrics3020018. Epub 2018 Apr 10.

A Statewide Model for Assisting Nursing Home Residents to Transition Successfully to the Community

Darci Buttke  1 , Valerie Cooke  2 , Kathleen Abrahamson  3 , Tetyana Shippee  4 , Heather Davila  4 , Rosalie Kane  4 , Greg Arling  3
Affiliations

A Statewide Model for Assisting Nursing Home Residents to Transition Successfully to the Community

Darci Buttke et al. Geriatrics (Basel). 2018 Jun.

Abstract

Minnesota's Return to Community Initiative (RTCI) is a novel, statewide initiative to assist private paying nursing home residents to return to the community and to remain in that setting without converting to Medicaid. The objective of this manuscript is to describe in detail RTCI's development and design, its key operational components, and characteristics of its clients and their care outcomes. Data on client characteristics and outcomes come from the Minimum Data Set, staff assessments of clients and caregivers, and Medicaid eligibility files. Most clients transitioned by the RTCI had entered the nursing facility from a hospital. Clients overwhelmingly wanted to return to the community and fit a health and functional profile making them good candidates for community discharge. Most clients went to a private residence, living alone or with a spouse; yet, adult children were the most frequent caregivers. At one year of follow-up 76% of individuals were alive and living in the community and only a small percentage (8.2%) had converted to Medicaid. The RTCI holds promise as a successful model for states to adopt in assisting individuals who are at risk to become long stay nursing home residents instead to return to the community.

Keywords: caregiving–informal; decision making; evaluation.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: We note that some authors of the article (D.B. and V.C) have been involved in the development and implementation of the RTCI. The authors have no further conflicts of interest to declare.

Similar articles

See all similar articles

Cited by

References

    1. Keehan S.P., Poisal J.A., Cuckler G.A., Sisko A.M., Smith S.D., Madison A.J., Stone D.A., Wolfe C.J., Lizonitz J.M. National Health Expenditure Projections, 2015–25: Economy, Prices, and Aging Expected to Shape Spending and Enrollment. Health Aff. 2016;35:1522–1531. doi: 10.1377/hlthaff.2016.0459. - DOI - PubMed
    1. Arling G., Kane R.L., Cooke V., Lewis T. Targeting residents for transitions from nursing home to community. Health Serv. Res. 2010;45:691–711. doi: 10.1111/j.1475-6773.2010.01105.x. - DOI - PMC - PubMed
    1. Centers for Medicare & Medicaid Services (CMS) Money Follows the Person. [(accessed on 10 October 2017)];2016 Available online: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Lon....
    1. Morris E. Money Follows the Person Demonstration: Overview of State Grantee Progress, January to December 2015. Mathematica Policy Research; Cambridge, MA, USA: 2016. Final Report Submitted to the Centers for Medicare and Medicaid Services.
    1. Thomas K.S., Mor V. The relationship between older Americans Act Title III state expenditures and prevalence of low-care nursing home residents. Health Serv. Res. 2013;48:1215–1226. doi: 10.1111/1475-6773.12015. - DOI - PMC - PubMed

LinkOut - more resources