Efforts to enhance nursing home diversion and transition are effective
New approaches can keep high-risk individuals at home
Per-person spending on nursing home care is 52 percent higher in Ohio than the national average. The approximately 173,000 Ohioans who need long-term care account for seven percent of Medicaid enrollment but 41 percent of the program's spending, according to Ohio Medicaid director John McCarthy. Medicaid supports two-thirds of Ohio's nursing home residents. During the 2009 legislative session, the Ohio General Legislature asked the Ohio Department of Aging to develop a new nursing home diversion and transition program to help individuals live in home- and community-based settings.
The department created a workgroup of staff from Ohio's 13 PASSPORT Administrative Agencies (PAAs) and chose interventions that were appropriate for their respective regions. The workgroup focused on two target populations:
- The diversion group were individuals who were at high risk of nursing home placement and who were currently in the community, hospital or short-term nursing home.
- The transition group included people who lived in nursing homes, but who could possibly return to live in the community.
Previous studies have shown that almost half of the participants leaving Medicaid waiver programs enter a nursing home. For individuals in this trial, PAAs increased the amount and intensity of in-home services, enhanced caregiver training and support, and implemented a more proactive plan for waiver participants who entered a nursing home for a short-term stay. For individuals who were not in a waiver program, diversion activities included emphasis on working with hospitals and other providers, such as home health and social service agencies, to identify high risk consumers. Several of the PAAs placed staff members in hospitals to enhance this link.
PAAs used databases to identify nursing home residents who were transition candidates. One database included the results to the question as to whether the resident would like to return to the community. The second database included all individuals who received a pre-admission review before they entered the nursing homes. The long-term care ombudsmen and nursing home staff also were important partners. PAAs sent staff into facilities to work with residents and explore the feasibility of returning to the community. For residents who chose transition to the community, the staff member developed a plan and arranged for the necessary services to facilitate the move.
The PAAs began the diversion and transition activities in March 2010. During a one-year period, 3,233 at risk Ohioans agreed to participate (1,974 diversions and 1,259 transitions). After six months, Scripps Gerontology Center at Miami University conducted a follow-up study to examine the impact the intervention had on the consumers. They found that after six months, about two-thirds of the consumers identified for diversion remained in the community, 17 percent lived in a nursing home and 18 percent had died. Of the nursing home residents in the transition program, more than half (53 percent) were living in the community after six months, 23 percent remained in the nursing home and 10 percent had died.
The Scripps team will continue to track the consumers through May 2011. A final report will be released by the end of June and will include detailed information about the strategies used, a review of promising practices for diversion and transition, as well as barriers to success.
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