Assessing the Impact of Minnesota’s Return to Community Initiative for Newly Admitted Nursing Home Residents: A Regression Discontinuity Approach

The goal of Minnesota’s Return to Community Initiative (RTCI) is to facilitate community discharge for non-Medicaid nursing home residents who are early in their stays and who wish to return to the community but are at risk of becoming permanent nursing home residents. The intervention consists of program staff assisting residents and family caregivers with discharge planning, transitioning to the community, and post discharge follow up. A key evaluation question is how many of those transitions were directly attributable to the program. RTCI was implemented statewide leaving no control group for estimating such an effect. The program did, however, use a score based on resident likelihood to discharge to target resources to residents most likely to benefit from the intervention. A score above the cut-point of 70 (range 0-99) placed a resident in the target group. The sample consisted of 18,444 non-Medicaid nursing home admissions in Minnesota who remained in a facility for at least 45 days. Program impact was measured using regression discontinuity. If RTCI were effective, we would expect a significant increase in community discharge rates for residents with scores above the targeting cut-point. We tested alternative estimation methods using a fuzzy design. We found that RTCI increased community discharge rates by 11% (p < .0001) for the targeted population. The program effect was consistent across time periods and it increased in line with level of facility participation in RTCI. The RTCI had a modest yet significant impact on the community discharge rates for its targeted population of non-Medicaid nursing home residents. Findings from the evaluation have been applied in strengthening the RTCI’s targeting approach and transitioning process.