. Although many persons with Alzheimer's disease and related dementia (ADRD) eventually enter nursing homes (NHs) for care, most prefer to stay at home for as long as possible. Community-dwelling persons with ADRD are often cared for by informal (unpaid) caregivers such as relatives or friends. However, such care is often not sustainable over the course of illness, considering the intensive care needs of persons with ADRD. As the disease progresses, NH placement may become a necessity. For those ADRD patients who are enrolled in (or are eligible for) Medicaid, there exist home and community based services (HCBS) that provide support to potentially prevent or delay NH placement. HCBS can be delivered through either the state plan or waivers, with wide variations in service coverage and eligibility requirements across states. To date, little is known regarding the use of HCBS among persons with ADRD, and how the generosity of ADRD- relevant HCBS policies is related to risks of NH placement among persons with ADRD. Furthermore, while there is ample evidence that Blacks are more likely to have ADRD, have higher levels of cognitive impairment, less social support, and more unmet needs, compared to Whites, no study has examined presence of racial differences in utilization of HCBS or its impact on risks of NH placement among persons with ADRD. Taking advantage of the variations in the provision of HCBS across states, the rapid expansion in HCBS over the years, and the recently developed HCBS taxonomy, the main objective of this study is to describe the use (and types) of HCBS among persons with ADRD, to examine the relationship between the generosity of HCBS policies and the risk of NH placement and to explore potential racial differences in the use of HCBS and related outcomes among persons with ADRD. The proposed research fits within the scope of the parent grant because it focuses on a vulnerable older population (ADRD) at risks of being admitted to NHs. The proposed study has 3 Specific Aims (SAs): 1) Explore the use of HCBS among persons with ADRD and variations in the generosity of ADRD-relevant HCBS over time and across states; 2) Examine the relationship between the generosity of ADRD-relevant HCBS and NH placement among persons with ADRD. We hypothesize that with the increase in the generosity of HCBS, persons with ADRD are less likely to be admitted to NHs for custodial care/long-term care; and are more impaired at the time of NH admission. We will also explore the types of HCBS that may be more beneficial to persons with ADRD; and 3) Explore racial differences in the use of HCBS and in the relationship between the generosity of ADRD-relevant HCBS and risks of NH admissions among persons with ADRD. This study is significant as it addresses a growing public health concern regarding the delivery of patient-centered care to persons with ADRD. Findings from this study will help to understand the potential impact of HCBS investment and types of services on community living among persons with ADRD. The findings will also establish premise for future studies.
The proposed administrative supplement is highly relevant to public health because it addresses a growing public health concern regarding the delivery of patient-centered care to persons with ADRD. Supporting community living for individuals with ADRD aligns with the goal of patient centered care ? it improves patients' quality of care and life by allowing them to stay at home and receive support from their families, while minimizing the caregiver burden. Findings from this study will help to understand the potential impact of Medicaid home and community based services (HCBS) investment and types of services on community living among persons with ADRD.
