Did Covid and the Transition to Telehealth Change Person-Reported Outcomes for Home and Community Based Care Recipients With and Without Alzheimer's Disease and its Related Dementias?

Providing high-quality home and community-based services (HCBS) for the millions of Americans living with Alzheimer's disease and related dementias (AD/ADRD) and their caregivers is a national priority. HCBS, often funded by Medicaid as an alternative to nursing homes, are preferred by individuals and their families. However, the COVID-19 pandemic disrupted HCBS, leading to temporary closures and a shift to virtual care. During the pandemic, HCBS providers had to adapt their services, temporarily eliminating some or permanently closing. States allowed the shift to virtual care, but individuals with AD/ADRD have complex medical conditions that may be challenging to address virtually. This disruption likely left consumers, especially those with AD/ADRD, with unmet needs. To understand the effects of the pandemic on HCBS use, unmet needs, and person-reported outcomes, our study aims to examine changes in HCBS used vs desired during the pandemic, including the use of virtual care. Data from the National Core Indicators-Aging and Disabilities (NCI-AD) Adult Consumer Survey will be analyzed, comparing pre-pandemic and pandemic periods. NCI-AD measures HCBS outcomes from consumers' perspectives and includes questions about experiences during the pandemic. The study has three specific aims: Aim 1A: Determine the change in used and desired HCBS by consumers with and without AD/ADRD before and during the COVID-19 pandemic. Aim 1B: Identify whether the use of virtual care moderates the differences between used vs desired HCBS during the pandemic for people with and without AD/ADRD. Aim 2A: Determine the change in HCBS person-reported outcomes for consumers with and without AD/ADRD before and during the COVID-19 pandemic. Aim 2B: Identify whether the use of virtual care moderates the differences between HCBS outcomes during the pandemic for consumers with and without AD/ADRD. Aim 3: Examine barriers and facilitators to HCBS virtual care implementation that could impact person- reported outcomes. The impact of this research is significant as it aligns with national recommendations to improve HCBS for AD/ADRD and will inform the viability of virtual care as a model for delivering HCBS. This is crucial given the growing interest in virtual care to address challenges in the post- pandemic era and the ongoing staffing issues in the healthcare system.