Racial Differences in Choice and Control Among Older Adults: Results From Connecticut’s Money Follows the Person Rebalancing Demonstration

ABSTRACT

We examined racial differences in determinants of choice and control in daily activities and service coordination for a sample of White and Black participants in the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration. Within-group analyses were conducted to understand factors that contribute to choice and control among participants. While no disparities were found in the odds of reporting choice and control, our findings show that White participants with mental health challenges, who lived with family, and had more functional impairments and Black participants with engagement transition challenges were less likely to have choice and control over daily activities. Determinants varied by race for choice in service coordination. Findings indicate a need for initiatives to target different factors for White and Black MFP participants to optimize opportunities for choice and control after returning to community living.

KEYWORDS:

• Minority issues
• race
• decision making
• autonomy and self-efficacy
• long-term care

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Includes hospitalization due to physical health.

2. Includes waiting for neuro-psych examination.

3. Includes taking medications correctly; following up with treatment or care; self-monitoring of blood sugar, etc.

4. Includes emotional issues such as depression or anxiety or behavioral issues related to mental health. Includes hospitalization due to mental health issues.

5. Includes abuse of legal drugs such as abuse of prescription medications.

6. Includes impaired judgment due to cognitive issues.

7. Includes taking medications correctly; following up with treatment or care.

8. Includes lack of financial resources to pay security deposit or for services or supports.

9. Includes lack of/poor credit; unpaid balance or money owed to utilities, etc.

10. Includes denial, delay, loss, or lack of state or federal financial benefits; rejection or delay in application for financial benefits; over- or underpayment of benefits.

11. Includes related to the individual’s or spousal finances; missing documents/records; denial, loss of, or waiting for approval of other benefits, including benefits such as food stamps or energy assistance. Excludes cash benefits from SSDI, SSI, SSD.

12. Includes over income, over assets, legal resident status, or other Medicaid eligibility issues; issues with prescription insurance coverage, Medicare Part D, Medicaid, SAGA medical insurance, etc.

13. Includes lack of follow through on responsibilities; decision to remain in facility and withdraw from program.

14. Includes resistance to or inflexibility regarding need or options for support.

15. Includes whether self-directing, consumer cannot manage PCAs or other support staff.

16. Includes language differences, no interpreter (includes sign language interpreter), lack of communication device, etc.

17. Includes insufficient, denial, wait for, or loss of transportation. Includes transportation to receive treatment, see apartments, get documents necessary to transition, or live in community.

18. Includes insufficient, denial, wait for, difficulty obtaining, or loss of paid support staff.

19. Includes insufficient, denial, wait for, or loss of mental health services or supports, either in the facility or in the community.

20. Includes insufficient, denial, wait for, or loss of alcohol, substance abuse, or addiction services or supports, either in the facility or in the community.

21. Includes insufficient, denial, wait for, or loss of, or need for training for AT or DME; excludes home modifications or affordability issues.

22. Includes insufficient, denial of, wait for, or loss of any other types of services or supports (excludes PCA/direct support staff; mental health services, AT/DME, or home modifications.

23. Includes over cost cap.

24. Includes if no existing waiver for level of care, such as no 24-hour care waiver.

25. Includes insufficient accessible, affordable housing; denial of, wait for, or loss of accessible or committed housing; consumer dissatisfaction with or inflexibility available residence or living arrangement.

26. Includes modifications not completed or not yet authorized.

27. Includes previous evictions, foreclosure, unpaid rent or utility bills, or money owed to Housing Authority. Also includes registered sex offender status or history of arson if either affects housing.

28. Includes current criminal issues, such as incarceration.

29. Includes probate judge issues.

30. Includes lack of legal representative if applicable; legal representative opposed, unsupportive, unresponsive; pertains to any consumer legal representatives, such as conservator, guardian, etc.

31. Includes opposed, unsupportive, unresponsive, etc.

32. Includes delay in, wait for, or lack of any type of evaluation for which the facility/facility staff is responsible.

33. Includes denial, pending appeal, short term approval, etc.

34. Includes opposed, unsupportive, unresponsive, etc. Includes financial exploitation.

35. Includes opposed, unsupportive, unresponsive, or absence of provider/state agency or their staff; includes care manager or care planner from provider or state agency (excludes staff from current facility).

36. Multiple additional areas can be created.

Additional information

Funding

This work was supported by the Centers for Medicare and Medicaid Services and the Connecticut Department of Social Services (grant number CFDA 93.779) (IRB# 09-020-2)