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Geriatrics 2018, 3(2), 18;

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

Minnesota Board on Aging, Saint Paul, MN 55101, USA
Valerie Cooke, Minnesota Department of Human Services, Saint Paul, MN 55101, USA
Kathleen Abrahamson, School of Nursing, Purdue University, West Lafayette, IN 47906, USA
Tetyana Shippee, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
Author to whom correspondence should be addressed.
Received: 9 March 2018 / Revised: 3 April 2018 / Accepted: 5 April 2018 / Published: 10 April 2018
(This article belongs to the Special Issue Geriatric Care Models)
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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. View Full-Text
Keywords: caregiving–informal; decision making; evaluation caregiving–informal; decision making; evaluation
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Buttke, D.; Cooke, V.; Abrahamson, K.; Shippee, T.; Davila, H.; Kane, R.; Arling, G. A Statewide Model for Assisting Nursing Home Residents to Transition Successfully to the Community. Geriatrics 2018, 3, 18.

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