{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T05:20:41Z","timestamp":1770268841868,"version":"3.49.0"},"reference-count":6,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T00:00:00Z","timestamp":1523318400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R18HS020224"],"award-info":[{"award-number":["R18HS020224"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Minnesota\u2019s Return to Community Initiative (RTCI) is a novel, statewide initiative to assist private paying nursing home residents to return to the community and to remain in that setting without converting to Medicaid. The objective of this manuscript is to describe in detail RTCI\u2019s development and design, its key operational components, and characteristics of its clients and their care outcomes. Data on client characteristics and outcomes come from the Minimum Data Set, staff assessments of clients and caregivers, and Medicaid eligibility files. Most clients transitioned by the RTCI had entered the nursing facility from a hospital. Clients overwhelmingly wanted to return to the community and fit a health and functional profile making them good candidates for community discharge. Most clients went to a private residence, living alone or with a spouse; yet, adult children were the most frequent caregivers. At one year of follow-up 76% of individuals were alive and living in the community and only a small percentage (8.2%) had converted to Medicaid. The RTCI holds promise as a successful model for states to adopt in assisting individuals who are at risk to become long stay nursing home residents instead to return to the community.<\/jats:p>","DOI":"10.3390\/geriatrics3020018","type":"journal-article","created":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T13:06:08Z","timestamp":1523365568000},"page":"18","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A Statewide Model for Assisting Nursing Home Residents to Transition Successfully to the Community"],"prefix":"10.3390","volume":"3","author":[{"given":"Darci","family":"Buttke","sequence":"first","affiliation":[{"name":"Minnesota Board on Aging, Saint Paul, MN 55101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Cooke","sequence":"additional","affiliation":[{"name":"Valerie Cooke, Minnesota Department of Human Services, Saint Paul, MN 55101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Abrahamson","sequence":"additional","affiliation":[{"name":"Kathleen Abrahamson, School of Nursing, Purdue University, West Lafayette, IN 47906, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetyana","family":"Shippee","sequence":"additional","affiliation":[{"name":"Tetyana Shippee, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Davila","sequence":"additional","affiliation":[{"name":"Tetyana Shippee, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalie","family":"Kane","sequence":"additional","affiliation":[{"name":"Tetyana Shippee, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"Arling","sequence":"additional","affiliation":[{"name":"Kathleen Abrahamson, School of Nursing, Purdue University, West Lafayette, IN 47906, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,4,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1377\/hlthaff.2016.0459","article-title":"National Health Expenditure Projections, 2015\u201325: Economy, Prices, and Aging Expected to Shape Spending and Enrollment","volume":"35","author":"Keehan","year":"2016","journal-title":"Health Aff."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1111\/j.1475-6773.2010.01105.x","article-title":"Targeting residents for transitions from nursing home to community","volume":"45","author":"Arling","year":"2010","journal-title":"Health Serv. Res."},{"key":"ref_3","unstructured":"Centers for Medicare & Medicaid Services (CMS) (2017, October 10). Money Follows the Person, Available online: https:\/\/www.medicaid.gov\/Medicaid-CHIP-Program-Information\/By-Topics\/Long-Term-Services-and-Supports\/Balancing\/Money-Follows-the-Person.html."},{"key":"ref_4","unstructured":"Morris, E. (2016). Money Follows the Person Demonstration: Overview of State Grantee Progress, January to December 2015, Mathematica Policy Research. Final Report Submitted to the Centers for Medicare and Medicaid Services."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1111\/1475-6773.12015","article-title":"The relationship between older Americans Act Title III state expenditures and prevalence of low-care nursing home residents","volume":"48","author":"Thomas","year":"2013","journal-title":"Health Serv. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1377\/hlthaff.26.6.1762","article-title":"Prospects for transferring nursing home residents to the community","volume":"26","author":"Mor","year":"2007","journal-title":"Health Aff."}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/3\/2\/18\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:00:13Z","timestamp":1760194813000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/3\/2\/18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,10]]},"references-count":6,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,6]]}},"alternative-id":["geriatrics3020018"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics3020018","relation":{},"ISSN":["2308-3417"],"issn-type":[{"value":"2308-3417","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,10]]}}}