Project Grant F31AG099518

COMMUNITY-BASED AGING FOLLOWING HEALTH SHOCKS: EXAMINING THE ROLE OF HOUSING ENVIRONMENTS - PROJECT SUMMARY EVERY YEAR, OVER 2 MILLION OLDER ADULTS EXPERIENCE HEALTH SHOCKS REQUIRING TEMPORARY CARE IN SKILLED NURSING FACILITIES (SNFS). WHILE THE GOAL OF SNF CARE IS REHABILITATION AND RECOVERY TO ENABLE SAFE COMMUNITY DISCHARGE, OVER HALF OF OLDER ADULTS FAIL TO ACHIEVE THIS OUTCOME. SUCCESSFUL COMMUNITY DISCHARGE IS A MEDICARE QUALITY MEASURE DEFINED AS DISCHARGING FROM A SNF WITHIN 100 DAYS AND REMAINING IN THE COMMUNITY FOR 30 DAYS WITHOUT REHOSPITALIZATION, READMISSION TO A SNF, OR DEATH. EVEN AMONG THOSE WHO ACHIEVE SUCCESSFUL COMMUNITY DISCHARGE, MANY STRUGGLE WITH LONG-TERM COMMUNITY-BASED AGING DUE TO DECREASED LEVELS OF PHYSICAL FUNCTION AND INCREASED SUPPORT NEEDS. THIS PLACES THEM AT HIGH RISK FOR LONG-TERM NURSING HOME PLACEMENT AND BECOMING HOMEBOUND. HOUSING ENVIRONMENTS ARE RECOGNIZED AS A CRITICAL FACTOR OF OLDER ADULTS' ABILITY TO SAFELY AGE IN THEIR COMMUNITY; HOWEVER, HOUSING ENVIRONMENTS HAVE NEVER BEEN STUDIED FOR HOW IT MAY ACT AS A BARRIER TO SUCCESSFUL COMMUNITY DISCHARGE AND COMMUNITY-BASED AGING FOLLOWING CARE IN A SNF. BARRIERS IN THE HOUSING ENVIRONMENTS CAN BE EFFECTIVELY ADDRESSED AND THEREFORE ARE POTENTIAL TARGETS FOR CARE TRANSITION INTERVENTIONS TO SUPPORT COMMUNITY-BASED AGING FOLLOWING SNF EPISODES. USING 13 YEARS OF LONGITUDINAL, NATIONALLY-REPRESENTATIVE DATA FROM THE NATIONAL HEALTH AND AGING TRENDS STUDY LINKED WITH MEDICARE CLAIMS DATA AND SNF ASSESSMENT DATA, THIS RESEARCH AIMS TO: 1) CHARACTERIZE LATENT CLASSES OF HOUSING ENVIRONMENTS AND DESCRIBE DEMOGRAPHIC, SOCIAL, ECONOMIC, AND CLINICAL DIFFERENCES ACROSS HOUSING ENVIRONMENT CLASSES; 2) EXAMINE THE RELATIONSHIP BETWEEN LATENT CLASSES OF HOUSING ENVIRONMENT AND SUCCESSFUL COMMUNITY DISCHARGE FOLLOWING A SNF EPISODE; 3) EXAMINE THE RELATIONSHIP BETWEEN LATENT CLASSES OF HOUSING ENVIRONMENT AND CHANGES IN COMMUNITY-BASED AGING IN THE YEAR FOLLOWING SNF EPISODE. THIS EXPLORATORY RESEARCH WILL PROVIDE FOUNDATIONAL EVIDENCE FOR THE DEVELOPMENT OF CARE TRANSITION INTERVENTIONS THAT ADDRESS MODIFIABLE HOUSING ENVIRONMENT FACTORS. THE CANDIDATE, MARISSA BERGH, IS A DOCTORAL STUDENT AT NYU RORY MEYERS COLLEGE OF NURSING AND A GERIATRIC AND PALLIATIVE CARE NURSE WITH OVER EIGHT YEARS OF EXPERIENCE ACROSS HEALTHCARE SETTINGS INCLUDING INPATIENT, HOME HEALTH, AND TELEPHONIC CARE TRANSITION MANAGEMENT. THIS F31 FELLOWSHIP WILL PROVIDE ESSENTIAL TRAINING THROUGH AN EXCEPTIONAL MENTORSHIP TEAM WITH EXPERTISE IN SNF QUALITY CARE AND MEDICARE DATA ANALYSIS (DR. J. TRAVERS ALTIZER), COMPLEX DATA LINKAGE AND LATENT CLASS ANALYSIS (DR. K. ORNSTEIN), ADVANCED BIOSTATISTICS (DR. J. FLETCHER), HOUSING CONTEXT OF AGING (DR. S. OKOYE), AND CARE TRANSITIONS (DR. A BRODY). THIS TRAINING WILL POSITION THE CANDIDATE TO BECOME AN INDEPENDENT RESEARCHER FOCUSED ON DEVELOPING FUTURE CARE TRANSITION INTERVENTIONS THAT ADDRESS MODIFIABLE HOUSING BARRIERS AND ENABLE OLDER ADULTS TO AGE SUCCESSFULLY IN THEIR COMMUNITIES.