The Olmstead Case (Olmstead v.L.C. 1999) established national precedence for helping adults with disabiities who are insitutionalized in nursing homes to return to living in the community. Centers for independent living and other disability advocacy organizations have initiated a wide range of efforts to assist adults with disability to transition back into community living from inappropriate and unnecessary nursing home placements. This effort may be particularly challenging in rural areas, where there is a lack of services and supports. There has been little published research on the topic, however,and there are few standard protocols for providing this health-related service. Moreover, anecdotal reports suggest that secondary health conditions are rarely considered systematically as part of the transition process. This proposal represents a community-based participatory research collaboration to design and establish the use of evidence-based, disability appropriate nursing home transition practices by CILs and other community-based programs in assisting adults with disabilities return to living in the community from nursing home placements. The goals of this specific research project (R21) is to develop an understanding of the role of secondary conditions in nursing home transition services. We expect this work to lead to the modification of a previously demonstrated intervention, Living Well with a Disability (Ravesloot, Seekins, & White, in press) designd to help adults with disabilities manage secondary conditions. Specific objectives include: (a) Identify and assess current nursing home transition policies, procedures, and practices used by CILs and identify secondary conditions assessment and management strategies used by CILs in the nursing home transition process, (b) Assess how concerns about secondary conditions influence the transition planning process and adapt a health behavior model to describe the influence of secondary conditions on the transition process, and (c) Review and revise the established intervention, Living Well with a Disability, to fit within the new context and prepare an R01 proposal to conduct an experimental examination of the effectiveness of this new intervention. ? ? ?
