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.
Highlights
The public and private costs of long term care in the United States (US) will increase dramatically in the future, with nursing home and continuing care retirement facility costs projected to rise to $260 billion by 2026 [1]
Among residents targeted by the Return to Community Initiative (RTCI), half choose to remain in the nursing home, 14% received RTCI assistance, and
In findings not reported in the table, we found no significant differences in outcomes for targeted residents transitioned by RTCI and those who left the facility without RTCI assistance
Summary
The public and private costs of long term care in the United States (US) will increase dramatically in the future, with nursing home and continuing care retirement facility costs projected to rise to $260 billion by 2026 [1]. Minnesota’s Return to Community Initiative (RTCI) is a novel, state-wide initiative to assist private paying nursing home residents to return to the community early in their stays, e.g., 60–90 days after admission It complements Moving Home Minnesota (the state’s MFP program) and other programs aimed at Medicaid residents. The RTCI has been quite successful, winning awards for innovation, collaboration, and nursing home quality improvement from the Humphrey School of Public Policy at the University of Minnesota, Harvard Kennedy School of Government, Pioneer Institute, and SCAN Foundation In this manuscript, we will trace RTCI’s development, describe its key operational components, describe characteristics of its clients and their care outcomes, discuss challenges in implementing and evaluating RTCI, and present recommendations to other states and those in other countries that may be considering a similar initiative
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