Abstract
Objectives
With unprecedented demand for Medicaid long-term services and supports, states are
seeking to allocate resources in the most efficient way. Understanding the prevalence
of frailty and how it varies across home and community-based services (HCBS) populations
can assist states with more precise identification of individuals most in need of
services. Early identification of individuals more likely to experience frailty changes
could allow for enhanced care planning to prevent or slow the progression of decline.
Design
Longitudinal study.
Setting and Participants
Data from Connecticut’s assessment tool (based on interRAI-HC) were analyzed at 2
time points for 16,309 individuals receiving HCBS. The sample included assessments
completed between November 1, 2017 and July 15, 2020 across 4 groups: older adults
65+ years old meeting nursing facility level of care (NF LOC), older adults 65+ years
old not meeting NF LOC, individuals with acquired brain injury, and individuals <65 years
old with physical disability.
Methods
We measured frailty using the Frailty Index (FI) and examined change in FI between
baseline and follow-up. A change in FI score of at least ±0.03 was classified as a
clinically meaningful change. We compared predictors of clinically meaningful decline
or improvement using multivariate logistic regression.
Results
In our sample, 54% of individuals experienced a clinically meaningful change: 42%
declined and 12% improved. Individuals receiving in-home care services had lower odds
of improvement across all HCBS groups and multiple frailty categories with odds ratios
ranging from 0.35 to 0.68. Frail older adults 65+ years old meeting nursing facility
level of care receiving physical therapy were 21% less likely to experience decline
and 1.4 times more likely to improve.
Conclusions and Implications
The nature of HCBS support provided can impact changes in frailty status. More reactive
services such as in-home care may contribute to frailty decline while rehabilitative
services such as physical therapy may protect against decline.
Keywords
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Article info
Publication history
Published online: August 19, 2021
Footnotes
This work was supported in part by the Connecticut Department of Social Services, Grant 13DSS7102IK. The sponsor played no role in design, methods, analysis, or preparation of the paper.
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
