Home And Community-based Services Research Articles

Factors Associated with the Utilization of Home and Community-Based Services (HCBS) Among Older Adults: A Systematic Review of the Last Decade

ABSTRACT Home and community-based services (HCBS) for older adults have been promoted worldwide to address the growing problems of aging. This systematic review included 59 studies published from 2013 to 2023 to explore factors influencing the utilization of HCBS among older adults. The review identified 15 common factors grouped into four levels of influence: individual, inter-relationship, community, and social contextual levels. The findings suggest that HCBS utilization is a dynamic process influenced by multiple factors at different levels. Gerontological social work should incorporate ecological thinking to improve practice and strengthen caregiver-recipient relationships.

Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services.

This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180days after SNF discharge. We found that higher HCBS generosity was associated with an increased likelihood of remaining in the community. HCBS breadth and intensity were both significantly associated with reduced risks of NH admission, while higher HCBS intensity was related to a reduced risk of acute hospitalizations within 30days after discharge. Our findings suggest that more generous HCBS programs may facilitate smoother transitions and sustainable community living following SNF discharge.

Differences in healthcare utilization between enrollees of fully integrated dual eligible special needs plans versus non-fully integrated plans.

Policymakers advocate care integration models to enhance Medicare and Medicaid service coordination for dually eligible individuals. One rapidly expanding model is the fully integrated dual eligible (FIDE) plan, a sub-type of the dual eligible special needs plan (D-SNP) in which a parent insurer manages Medicare and Medicaid spending for dually eligible individuals. We examined healthcare utilization differences among dually eligible individuals aged 65 years or older enrolled in D-SNPs by plan type (FIDE vs non-FIDE). Using 2018 Medicare Advantage encounters and Medicaid claims of FIDE and non-FIDE enrollees in six states (AZ, CA, FL, NY, TN, WI), we compared healthcare utilization between plan types, adjusting for enrollee characteristics and county indicators. We applied propensity score weighting to address differences between FIDE and non-FIDE plan enrollees. In our main analysis, which included all dually eligible individuals in our sample, we observed no significant difference in healthcare utilization between FIDE and non-FIDE plan enrollees. However, we identified some differences in healthcare utilization between FIDE and non-FIDE plan enrollees in subgroup analyses. For example, among home and community-based service (HCBS) users, FIDE plan enrollees had 6.0 fewer hospitalizations per 1000 person-months (95% CI: -7.9, -4.0) and were 7.0 percentage points more likely to be discharged to home (95% CI: 2.6, 11.5) after hospitalization, compared to non-FIDE plan enrollees. While we found no differences in healthcare utilization between FIDE and non-FIDE plan enrollees when considering all dually eligible individuals in our sample, some differences emerged when focusing on subgroups. For example, HCBS users with FIDE plans had fewer hospitalizations and were more likely to be discharged to their home following hospitalization, compared to HCBS users with non-FIDE plans. These findings suggest that FIDE plans may improve care coordination for specific subsets of dually eligible individuals.

Urban-Rural Disparities in the Association Between Home- and Community-Based Service Utilization and Levels of Disability Among Chinese Older Adults With Disabilities.

Home- and community-based services (HCBS) are optimal ways to deal with disability problems among older adults. This study aims to analyze urban-rural disparities in the relationship between HCBS utilization and levels of disability among Chinese older adults with disabilities, so as to meet the long-term care needs of them. In applying the Andersen Behavioral Model, bivariate analysis and multivariate regression models were employed using data from 843 older adults with disabilities from the 2018 China Longitudinal Aging Social Survey (CLASS). After adjusting covariates, disability levels among Chinese older adults with disabilities were significantly correlated with HCBS utilization in urban areas but not in rural areas. The urban-rural disparities may be due to the low utilization of HCBS in rural areas (only 11.2%) among older adults with disabilities compared with their urban counterparts (22.7%).

Outcomes of Person-Centered Planning in Medicaid Home and Community-Based Services.

Person-centered planning (PCP) allows recipients of home and community-based service (HCBS) to plan services and supports according to their preferences and needs. The extent to which HCBS systems engage in PCP and evidence for the relationship between PCP and beneficiary outcomes is limited. We examine the prevalence of PCP among HCBS recipients and the relationship between PCP and person-reported outcomes. We used the 2018-2019 National Core Indicators-Aging and Disability survey, collected among adult Medicaid HCBS recipients in 12 states (n = 5,849). We examined two general PCP measures (one on decision-making and another on whether service plans reflected preferences/choices). We also constructed a scale to assess the fidelity of recipients' service planning meeting to the person-centered planning process. Outcomes included unmet service needs and community living (i.e., participation, control, and satisfaction). We examined recipient characteristics associated with PCP and used adjusted logistic regression models to assess the relationship between PCP and outcomes. About 72% of HCBS recipients were involved in decision-making, 72% reported their service plan reflected their preferences/choices, and 47% had meetings that scored "high fidelity" on the PCP fidelity scale. PCP measures were consistently related to lower likelihood of unmet service needs and greater likelihood of experiencing community living outcomes. Findings suggest PCP is important for adequately meeting service needs and ensuring community living among HCBS beneficiaries. Additional standardized measures should be developed to facilitate quality improvement and accountability for delivering person-centered HCBS.

Higher levels of state funding for Home- and Community-Based Services linked to better state performances in Long-Term Services and Supports.

To examine the relationship between the level of state funding for Home- and Community-Based Services (HCBS) and state overall and dimension-specific performances in Long-Term Services and Supports (LTSS). We employed state-level secondary data from the Medicaid LTSS Annual Expenditures Reports, the American Association of Retired Persons (AARP) State Scorecards, the U.S. Census, and Federal Reserve Economic data, spanning the timeframe of 2010-2020. Overall state LTSS rankings, along with dimension-specific rankings, were modeled separately against state Medicaid spending on HCBS relative to total Medicaid spending on LTSS. All models were adjusted for state covariates, secular trend, and state fixed effects. The study sample included all 50 states and the District of Columbia. However, California, Delaware, Illinois, and Virginia were excluded from FY2019 due to missing data on Medicaid HCBS expenditures. Every 10 percentage-point increase in the proportion of Medicaid LTSS spending to HCBS demonstrated 2.05 points improvement (95% confidence interval [CI]: -3.88 to 0.22, p = 0.03) in rankings for state overall LTSS system performance, 2.92 points improvement (95% CI: -4.87 to 0.98, p < 0.01) in rankings for the Choice of Setting and Provider dimension, as well as 1.73 points (95% CI: -3.14 to 0.32, p = 0.02) ranking improvement in the dimension of Effective Transitions. Our study suggested promising effects of increased state funding for HCBS on LTSS performance.

Association between home and community-based services utilization and self-rated health among Chinese older adults with chronic diseases: evidence from the 2018 China Health and Retirement Longitudinal Study

BackgroundAs global aging intensifies, older adults with chronic diseases are of increasing concern. Home and community-based services (HCBSs) have been proven to promote self-rated health (SRH) in older adults, but no research explored the associations between the use of overall HCBSs, three different types of HCBSs (health care, daily care, and social support services) and SRH among older adults with chronic diseases. Consequently, this study applies a national publicly available database to examine these associations among older adults with chronic diseases.Methods8,623 older adults with chronic diseases (≥ 60 years old) were included in this study. SRH was evaluated applying a concise question with a 1 − 5 scale. HCBSs utilization was assessed through the question, “What kind of HCBSs were used in the community?”. Univariate general linear regression models aimed to compare the mean values of SRH in terms of HCBSs utilization in each group. This study is a cross-sectional study design and the relationship between HCBSs utilization and SRH was assessed by multilevel linear regression.ResultsThe mean score for SRH among the respondents was 3.19, of whom 20.55% used one or more HCBSs, 19.47% utilized health care services, 2.44% utilized social support services, and only 0.55% utilized daily care services. The use of HCBSs was found to be linked to SRH among older adults with chronic diseases (β = 0.085, SE = 0.025, p < 0.001). SRH among older adults with chronic diseases was strongly linked to the use of health care and social support services (β = 0.068, SE = 0.025, p < 0.001; β = 0.239, SE = 0.063, p < 0.001, respectively). However, there was no significant association between the use of daily care services and SRH among older adults with chronic diseases.ConclusionThis study revealed that HCBSs utilization was positively and significantly linked to SRH in Chinese older adults with chronic diseases. Furthermore, this study supposes the low utilization of social support and daily care services may be due to a mismatch between supply and demand. The government should offer the targeted HCBSs for older adults with chronic diseases according to their unique features to enhance their health status.

The relationship between Medicaid policy and realized access to home- and community-based services

ABSTRACT Medicaid funding for home- and community-based services (HCBS) has increased substantially in recent decades. Prior research has investigated the effects of this expansion on outcomes for individuals as well as costs to Medicaid, often using state policy as a proxy for access to HCBS or implicitly assuming that more generous policies affect outcomes through access, an assumption that may not hold. In this study, using survey data linked to Medicaid claims, we assess the extent to which common measures of state Medicaid HCBS generosity correspond to increased individual use of HCBS among older adults with potential needs. We find several measures to have strong predictive power, but only with relatively large changes in policy generosity. Our findings imply that increased funding of HCBS is not sufficient to ensure access to services and that researchers should be careful when using state policy generosity as a proxy for access.

Barriers to Community Service Use Among Persons With Dementia and Their Care Partners: A Focus on Consumers of a Novel Statewide Dementia Care Program.

Although the importance of access to, and utilization of, home and community-based services (HCBS) is a well-documented aspect of informal care and the ability to age in place among people living with dementia, these resources are underutilized, especially in the initial stages of the disease. In 2017, the Georgia Memory Net was established as a novel private-public partnership to extend dementia screening, diagnosis, care planning, and direct HCBS connections for people with memory concerns throughout the State of Georgia. We aimed to identify barriers and facilitators to HCBS utilization following a dementia diagnosis and subsequent referral for services. Data were collected through in-depth interviews with 7 Georgia Memory Net patients and 19 care partners (unconnected dyads) and analyzed using thematic analysis. We found that even with a direct handoff, many people do not use HCBS and face barriers to accessing services. We offer several recommendations based on these findings.

State home and community-based services expenditures and unmet care needs in the United States: Has everyone benefitted equally?

To test whether the impacts of Medicaid's Home and Community-Based Services (HCBS) expenditures have been equitable. This is a secondary data analysis. We linked annual data on state-level Medicaid HCBS expenditures with individual data from U.S. Health and Retirement Study (HRS; 2006-2016). We evaluated the association between state-level HCBS expenditure quartiles and the risk of experiencing challenges in basic or instrumental activities of daily living (I/ADLs) without assistance (unmet needs for care). We fitted generalized estimating equations (GEE) with a Poisson distribution, log link function, and an unstructured covariance matrix. We controlled demographics, time, and place-based fixed effects and estimated models stratified by race and ethnicity, gender, and urbanicity. We tested the robustness of results with negative controls. Our analytic sample included HRS Medicaid beneficiaries, aged 55+, who had difficulty with ≥1 I/ADL (n = 2607 unique respondents contributing 4719 person-wave observations). Among adults with IADL difficulty, higher quartiles of HCBS expenditure (vs. the lowest quartile) were associated with a lower overall prevalence of unmet needs for care (e.g., Prevalence Ratio [PR], Q4 vs. Q1: 0.91, 95% CI: 0.84-0.98). This protective association was concentrated among non-Hispanic white respondents (Q4 vs. Q1: 0.82, 95% CI: 0.73-0.93); estimates were imprecise for Hispanic individuals and largely null for non-Hispanic Black participants. We found no evidence of heterogeneity by gender or urbanicity. Negative control robustness checks indicated that higher quartiles of HCBS expenditure were not associated with (1) the risk of reporting I/ADL difficulty among 55+ Medicaid beneficiaries, and (2) the risk of unmet care needs among non-Medicaid beneficiaries. The returns to higher state-level HCBS expenditures under Medicaid for older adults with I/ADL disability do not appear to have been equitable by race and ethnicity.

THE ROLE OF MEDICAID HOME- AND COMMUNITY-BASED SERVICES IN USE OF MEDICARE POST–ACUTE CARE

Abstract Medicaid-funded long-term services and supports are increasingly provided through home and community-based services (HCBS) to promote continued community living. While an emerging body of evidence examines the direct benefits and costs of HCBS, there may also be unexplored synergies with Medicare-funded post-acute care (PAC). This study aims to provide empirical evidence on how the use of Medicaid HCBS influences Medicare PAC utilization among the dually enrolled. Using national Medicare claims, Medicaid claims (TAF), MDS, and OASIS data from 2014 to 2017, we estimated the relationship between prior Medicaid HCBS use and PAC utilization in a national sample of duals with qualifying index hospitalizations. We used inverse probability weights to create balanced samples on observed characteristics and estimated multivariable regression with hospital fixed effects and extensive controls. We also conducted stratified analyses for key subgroups and tested for interactions between HCBS use and three measures of states’ HCBS generosity. We found HCBS use was associated with a 5.2 percentage-point increase in use of any Medicare-funded PAC, a 7.2 percentage-point increase in home health use, a 2.1 percentage-point decrease in institutional PAC, and a 1.95-day reduction of skilled nursing facility length of stay. In other words, use of Medicaid-funded HCBS was associated with a shift in Medicare-funded PAC use toward home-based settings. These findings were stronger in states with more generous HCBS funding. As we found that use of Medicaid-funded HCBS may alter choices about Medicare-funded PAC use, this synergy with HCBS should be considered by policymakers when contemplating further HCBS expansions.

STATE GENEROSITY IN HOME- AND COMMUNITY-BASED SERVICES (HCBS): VARIATIONS AND IMPACT ON DEMENTIA OUTCOMES

Abstract To meet the needs of community-living older adults and reduce overall medical spending, home- and community-based services (HCBS) provide assistance and care for persons with significant physical and cognitive limitations. Together, Medicaid long-term services and supports (LTSS) coverage and the Title III program under the Older Americans Act (OAA) of 1965 support the majority of the HCBS for older adults living in the U.S. with low-income and/or disabilities. We evaluated state variations in generosity of supporting HCBS in recent years and how these variations affect the healthcare outcomes of community-living older adults and socio-economic and racial disparities in dementia outcomes. State HCBS generosity from the perspectives of program participation and intensity of services was defined by the exploratory and the confirmatory factor analysis with data from multiple sources, including state reports from the National Association of State Budget Officers. State data was linked to a nationally representative sample of older adults who enrolled in the Health and Retirement Study in 2020. Analyses revealed that overall state supports for HCBS increased over time in recent years while state Medicaid expenditures for institutional long-term care remained largely stable. State supports through both Medicaid and the OAA programs for HCBS varied substantially and persisted in recent years. Discussion will focus on instrumental variable analyses that determine the causal impact of state variations in HCBS generosity on health outcomes (i.e., unmet need; hospitalization) for persons living with dementia persons.

Changes in Care Associated With Integrating Medicare and Medicaid for Dual-Eligible Individuals

There is growing interest in expanding integrated models, in which 1 insurer manages Medicare and Medicaid spending for dually eligible individuals. Fully integrated dual-eligible special needs plans (FIDE-SNPs) are one of the largest integrated models, but evidence about their performance is limited. To evaluate changes in care associated with integrating Medicare and Medicaid coverage in a FIDE-SNP in Pennsylvania. This cohort study using a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted between February 2022 and June 2023. Analyses examined outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. In the integration cohort, the mean (SD) age at baseline was 63.3 (14.7) years, and 5268 individuals (66.1%) were female and 2699 (33.9%) were male. In the comparison cohort, the mean (SD) age at baseline was 64.8 (18.6) years, and 2341 individuals (61.1%) were female and 1491 (38.9%) were male. At baseline, integration cohort members received a mean (SD) of 2.83 (8.70) days of HCBS per month and 3.34 (3.56) medications for chronic conditions per month, and the proportion with a follow-up outpatient visit after a hospital stay was 0.47. From baseline through 3 years after integration, HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month (95% CI, 0.28-0.94; P < .001). However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month; 95% CI, -0.10 to 0.06; P = .65) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay; 95% CI, -0.04 to 0.03; P = .61). Hospital stays did not change differentially between the cohorts. Unmeasured factors contributing to differential mortality limited the ability to identify changes in long-term nursing home stays associated with integration. In this cohort study with a difference-in-differences analysis of 2 cohorts of individuals dually eligible for Medicare and Medicaid, integration was associated with greater HCBS use but not with other changes in care patterns. The findings highlight opportunities to strengthen how integrated programs manage care and a need to further evaluate their performance.

USING COLLECTIVE IMPACT TO ASSESS HOME AND COMMUNITY-BASED SERVICES WORKER TRAINING AND CREDENTIALING

Abstract Older adults and people living with disabilities receive home- and community-based services (HCBS) from approximately 120,000 often poorly paid and inadequately supported direct care workers in North Carolina (NC). The demand for these workers is increasing rapidly, with NC projected to add almost 23,000 new direct care jobs from 2020 to 2030. With the goal of optimizing the workforce pipeline to prepare for the high need for HCBS across NC, we conducted a Medicaid-funded landscape analysis of direct care training/credentialing using Collective Impact (CI). CI is used for diverse collaborations through forming a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and “backbone” support (dedicated coordination team). Engaging with lived experiences is crucial in CI as it leads to sustainable decision-making informed by those affected by policy change. With input from long-term services and support agencies, licensing bodies, advocates, and those with lived experience, we characterized NC HCBS training/credentialing landscape, generating a first-of-its-kind comprehensive crosswalk resource for the state. Findings reveal the complexity of training/requirements, limited portability, lack of flexibility, and a need for more person-centered and relational core competencies. In addition, funding and incentives for additional training are lacking, which limits opportunities for professional development and career advancement. CI is an effective method to analyze direct care worker training/credentialing, it allowing researchers to harness the wisdom of community partners and incorporate lived experiences of the people most impacted by potential policy changes - workers, HCBS recipients, and families.

EMERGENCY DEPARTMENT USE AMONG OLDER ADULTS RECEIVING MEDICAID HOME- AND COMMUNITY-BASED SERVICES

Abstract Medicaid-funded home and community-based services (HCBS) for older adults aim to prolong independent living despite physical and cognitive disabilities. Medicaid-eligible HCBS populations are racially and ethnically heterogeneous, with multiple chronic conditions. Clinical threats to continued independent living among older adult HCBS recipients include acute illnesses, injuries, and exacerbations of chronic conditions, which could trigger a pathway of emergency department (ED) visits, hospitalization, and long-term nursing home admission. Despite its importance in the pathway from independent living, little is known about the rate of, or risk factors for, ED use in this target population. Accordingly, we determined predictors of ED use in a statewide cohort (N=5,651) in Connecticut’s Medicaid HCBS program for adults age &amp;gt;65, who were clinically assessed using a uniform tool between April 2020-March 2021. ED use, (0 vs 1+ visits), was ascertained over 12 months following clinical assessment using Medicare and Medicaid claims data. Predictor variables were racial and ethnic group, primary language, age, sex, educational attainment level, dementia diagnosis or moderate-severe cognitive impairment, depressive symptom severity, and Charlson comorbidity index. Cohort members were 76% female, 30% Hispanic, 15% non-Hispanic Black, 4% non-Hispanic Asian, 33% age &amp;gt;85. Forty-one percent had 1+ ED visits. Multivariate logistic regression analyses revealed that ED use was associated with (adjusted odds ratios p&amp;lt;0.05): high school education, more severe depressive symptoms, and more chronic conditions. Non-Hispanic Asian individuals had lowest ED visit likelihood. ED use among older adults receiving Medicaid HCBS might be reduced if depressive symptoms and multiple chronic conditions are optimally managed.

HIDDEN BARRIERS TO ENGAGING HOME- AND COMMUNITY-BASED SERVICES IN DEMENTIA CARE RESEARCH

Abstract The high prevalence of dementia in the United States has resulted in a reliance on home-and community-based services (HCBS) to assist in the provision of care for community-dwelling persons living with dementia. Partnering with HCBS organizations, like Adult Day Services (ADS), is beneficial to disseminating evidence-based dementia care interventions as it is an existing service that can be leveraged to foster relationships between research staff and clients. While benefits exist, challenges in identifying community-partner organization, ethical approval, and community-partner staffing can be unintended barriers. Using the ADS Plus Program as a case-study, this presentation will detail hidden barriers in engaging HCBS partnerships into dementia care research. Specifically, we will discuss barriers to 1) developing relationships to implement a multi-site national-trial, 2) high touch points necessary to engage sites from underrepresented populations, 3) institutional review board requirements (e.g. CiTi training, Federal Wide Assurance Forms), and 4) staff readiness to participate in research. We also offer recommendations based on lessons learned from the ADS Plus Program to enhance the pipeline from engagement with HCBS to participate in research to implementing an evidence-based interventions. Lessons learned from the ADS Plus Program demonstrates that changes are needed to improve the efficiency of the pipeline from community-based participation into dementia care research and implementation of evidence-based interventions.

ASSOCIATION OF MANAGED CARE ORGANIZATION HCBS QUALITY AND HEALTH CARE UTILIZATION

Abstract Providing high quality home and community-based services (HCBS) to older adults is a priority, but surprisingly little is known about the association between HCBS quality and client health care utilization. We linked data from the 2018 wave of the National Core Indicators-Aging and Disabilities (NCI-AD) Adult Consumer Survey for participants in the State of Minnesota enrolled in the Elderly Waiver (n=1,449) to their Centers for Medicare and Medicaid Services (i.e., claims data). We attributed respondents in our sample to 1 of 8 managed care organizations (MCOs) responsible for managing the health and HCBS of beneficiaries. For each MCO, we calculated overall plan level HCBS quality using a validated approach based on items in NCI-AD with subdomains of care experience, security and inclusion. Plan quality was the independent variable in a series of multivariate regressions that controlled for county and beneficiary characteristics. Outcomes (yes/no for any utilization in year) included: 1) hospitalizations, 2) emergency department, 3) home health, 4) durable medical equipment, 5) personal care assistance, 6) transportation, 7) case management, 8) home services, and 9) adult day. Quality was positively associated with case management utilization, but no other measure. As the market share of the highest quality plan in a county increased, all beneficiaries (regardless of MCO) in the county used more durable medical equipment, case management services, and adult day care. In conclusion, MCO quality may be driven by client encounters with plans via case managers. A next step is to determine the causal relationship between quality and outcomes.

THE ASSOCIATION BETWEEN PERSON-CENTERED PLANNING AND PERSON-REPORTED OUTCOMES IN HOME- AND COMMUNITY-BASED SERVICES

Abstract Person-centered planning (PCP) allows home and community-based service (HCBS) users to plan and coordinate services and supports according to their preferences and needs. The extent to which HCBS systems provide high-quality PCP and evidence for the relationship between PCP and user outcomes is limited. This study examines HCBS user characteristics related to PCP and the association between PCP and both unmet need and community living. We used the 2018-2019 National Core Indicators-Aging and Disability survey’s Person-Centered Planning Module, collected among adult Medicaid HCBS users in 12 states (n = 6,924). Independent variables included two general PCP measures (one on decision-making and another on preferences and choices being reflected in service plans) and a PCP fidelity scale to assess the extent to which users’ most recent service planning meeting was person-centered. Outcomes included two measures of unmet need for services and three measures of community living (i.e., participation, control, and satisfaction). We examined user characteristics associated with PCP and used logistic regression models to assess the relationship between PCP and outcomes. About 85% of users reported they were fully involved in decision-making, 77% reported their preferences and choices were reflected in their service plan, and 57% had their most recent service planning meeting coded as “high fidelity” on the PCP fidelity scale. Each marker of high-quality PCP was consistently related to lower likelihood of unmet need and greater likelihood of experiencing each community living outcomes. Findings suggest high-quality PCP is important for meeting HCBS users’ needs and improving community living outcomes.

PARTNERING TO IMPROVE CARE: STRENGTHENING THE FAMILY CAREGIVER AND HOME CARE WORKER RELATIONSHIP

Abstract Family caregivers and home care workers provide essential daily care for millions of older adults and individuals with disabilities across the United States—and together they constitute the backbone of home and community-based services (HCBS). In many cases, these unpaid and paid caregivers work closely together and share common knowledge, skills, experiences, and challenges. Yet the overlap and relationship between them remains relatively understudied. This session will describe the importance of strengthening the family caregiver/home care worker dyad and discuss promising developments in research, policy, and practice. We will then highlight a pilot training intervention designed to improve the shared knowledge and interpersonal competencies of family caregivers and home care workers. The intervention— Partnering to Improve Care: Direct Care Workers and Families—was developed by PHI (a national nonprofit research, public education, and consulting organization) in partnership with the Florida Pioneer Network, Home Instead, and Florida State University through the North and Central Florida Geriatrics Workforce Enhancement Partnership (GWEP). Informed by the PHI Coaching Approach®, the intervention consists of five parallel online training modules for family caregivers and for home care workers that utilize adult learner-centered teaching methods and reflect input from home care stakeholders. The modules portray common scenarios that family caregivers and home care workers face and aim to build communication and relationship skills that facilitate collaborative problem-solving and the provision of person-centered care. We will present key findings on the feasibility and acceptability of this intervention, discuss next steps in this research, and highlight broader policy and practice recommendations.

PROJECTION OF MEDICAID SPENDING ON PEOPLE WITH ALZHEIMER’S DISEASE AND OTHER RELATED DEMENTIAS

Abstract As the US population is aging, the number of people with Alzheimer’s Disease and Other Related Dementias (ADRD) is increasing. People with ADRD have high expenditures on medical care and long-term services and supports (LTSS). Medicaid is the largest single payor for LTSS, however, the literature on the demographic trends and epidemiology of people with ADRD does not offer projections of Medicaid spending. The goal of this study was to develop an estimate for future Medicaid spending for people with ADRD for the state of Pennsylvania. The approach taken was to develop a demographic projection of the size of the older population, then estimate the fraction of people with ADRD who are eligible for Medicaid. Next, we used estimates of current spending trends to project future spending through 2025. Nearly all Medicaid participants with ADRD are dually eligible for both Medicaid and Medicare, however, Medicare managed care encounter data were not available for analysis. Thus, the prevalence of ADRD was constructed using Medicaid and Medicare fee-for-service (FFS) claims data. Two alternate estimates of the prevalence of ADRD among Medicare managed care enrollees were used (same as Medicare FFS, or slightly lower). Estimates were generated under several growth rates in per person spending on home and community-based services (HCBS). The results shows that growth in HCBS spending is the largest factor in predicting spending, leading to estimates ranging from $2.8 billion to $3.5 billion. Future research will extend the model to additional years.