Transition from Home Care to Nursing Home: Unmet Needs in a Home- and Community-Based Program for Older Adults

Abstract

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.

Keywords:

• HCBS
• long-term care
• Medicaid waiver
• mixed methods
• rebalancing

Acknowledgments

This study was funded by the Centers for Medicare and Medicaid Services and the Connecticut Department of Social Services as part of the Connecticut state evaluation of the Money Follows the Person Rebalancing Demonstration, CFDA 93.779. The authors thank Irene Reed and Nancy Thompson for their assistance with data coding and staff at Connecticut Community Care, Inc., the Southwestern Connecticut Agency on Aging, and the Agency on Aging of South Central Connecticut for their assistance with providing CHCPE client data and organizing and participating in the focus groups. Finally, the authors thank Kathy Bruni and colleagues at the Connecticut Department of Social Services for providing the administrative CHCPE program data.