57P
Return to Community: Supporting Individuals As They Recover Their Lives through the Money Follows the Person Program
Money Follows the Person (MFP) helps Medicaid enrollees transition from institutional- to community-based care. The MFP Behavioral Health Pilot (BHP) investigates whether MFP-eligible individuals with mental health and/or substance abuse problems could successfully live in the community if offered appropriate, targeted supports. Four questions were addressed: Do Pilot services improve functioning and quality of life? Are improvements sustained over time? What percentage of BHP participants eventually return to a nursing facility (NF)? What factors predict the probability of return to NF?
Methods:
Study participants resided in a nursing facility for a minimum of three months, expressed a desire to live independently and were diagnosed with a mental health and/or substance abuse disorder. Participants received up to six months of services prior to community move-out and one year of services in the community. BHP services included weekly visits by a case manager/therapist who offered specialized Cognitive Adaptation Training, a psychosocial treatment assisting participants with activities of daily living, and substance abuse treatment. In addition, participants received ongoing home and community-based services through their Medicaid HMO. There were 213 participants in the study with matched Medicaid data showing nursing facility stays. Quality of Life and Functional Status were measured at 0, 90, 180, 270, 365, 540 and 730 days. Growth curve analysis was used to model change over time and logistic regression was used to test which variables (demographics, intervention services, health care utilization) predicted return to nursing facility.
Results:
Participants increased their functional status and quality of life, predominantly from baseline to 90 days, and then maintained gains across time. One hundred fifty or 70% of participants remained in the community: median tenure was 24 months; longest tenure was 65 months; and total community time was 314 group years. Over 50% of those who returned to nursing facility (n=63) were in community for 24 months or longer. Rate of in-patient hospitalization was the only reliable predictor of return to nursing facility. Participants experiencing 1 episode of in-patient care every six months (39% risk) were 1.93 times more likely to return compared with those experiencing 0 inpatient stays during six month periods (21% risk).
Implications:
The high percentage of BHP participants remaining in the community up to 5 years shows that as individuals age and may need nursing facility care, they can successfully recover their lives in the community even if they have behavioral health problems in addition to physical health problems. If hospitalization can be prevented through enhanced ambulatory care, rates and length of community tenure could be even higher. After initial relocation expenses, the Pilot annually saves Medicaid money since community care costs about 40% less than nursing facility care. Texas will soon be including more long term services such as mental health rehabilitative services under capitated managed care. BHP-like services should be considered for inclusion under managed care as they may help reduce costs and improve client outcomes.