Moving Back Into the Community: Obstacles for People With an Acquired Brain Injury or Physical Disability |
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| Affiliation: | 1. University of Connecticut Health Center, Center on Aging, Farmington, CT, USA;2. Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA;1. Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada;2. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada;3. Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada;4. GERAS Centre for Aging Research, Hamilton, Ontario, Canada;5. Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada;1. Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA;2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA;3. Department of Economics, Farmer School of Business, Miami University, Oxford, OH, USA;4. Scripps Gerontology Center, Miami University, Oxford, OH, USA;5. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;6. Division of Geriatrics, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;7. Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, NY, USA;1. Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA;2. Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA;3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA;4. Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA;5. Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA;1. School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia;2. Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia;3. Medical School, The University of Western Australia, Crawley, Western Australia, Australia;4. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia;5. Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia;6. Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia;1. Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA;2. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;3. MGH Institute of Health Professions, Boston, MA, USA;4. Meyers Primary Care Institute, Worcester, MA, USA;5. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA;1. Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea;2. Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea;3. Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea |
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| Abstract: | ObjectivesTo investigate transitions from long-term institutional care to the community in people with an acquired brain injury (ABI) or a physical disability (PD). Secondary objectives were to identify barriers in each group.DesignRetrospective observational study based on a person-centered plan and structured interviews to identify potential barriers.Setting and ParticipantsLong-term institutional care; 2954 Medicaid participants younger than 65 interested in community living.MethodsAnalysis with SPSS 25 of 445 people with an ABI and 2509 with a PD living in long-term care between December 2008 and November 2017. The main outcome was transition to the community. Secondary measures identified specific barriers such as consumer engagement, gender, and age.ResultsOf the 2954 total cases, 1810 (61.3%) transitioned to the community; 57.5% of the ABI group (n = 256) and 61.9% of the PD group (n = 1554) transitioned. Although the PD group transitioned at a slightly higher rate, no significant association was found between the program (ABI or PD) and the likelihood of transitioning [χ2 (df = 1) = 3.096, P = .078]. Overall, in the ABI group, difficulties with the funding program, OR = 0.373 ± 0.238, and other individuals, OR = 0.396 ± 0.344, decreased the odds of transitioning more than other challenges, whereas lack of consumer engagement, OR = 0.659 ± 0.100, had the strongest influence on preventing transitions in the PD group.Conclusions and ImplicationsLiving in the community improves quality of life and decreases costs. No previous studies have focused on the major obstacles for 2 specific groups, those with an ABI and those with a PD. Identifying transition rates and specific barriers for different groups is an important step to developing systems that will overcome these obstacles. In addition, the equivalent transition rates between these groups highlights the benefit of increased funding and range of services for those with complex needs and support requirements. |
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| Keywords: | Long-term care disability home- and community-based services community living acquired brain injury |
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