Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1013 — Evaluation of Three Models of All-Inclusive Care for Frail Elderly Veterans

Author List:
Weaver FM (MCHSPR, Hines VA Hospital)
Hickey E (CHQOER, Bedford VA)
Parker V (COLMR, Boston VA)
Hughes S (University of Illinois, Chicago)
Czarnowski E (CHQOER, Bedford VA)
Koelling K (VIREC, Hines VA)
Miskevics S (MCHSPR, Hines VA)
Manheim L (Northwestern University)

Objectives:
VA implemented three models of all-inclusive long term care for frail elderly veterans. Model I provided all care through VA; Model II was a partnership with a community provider (VA provided inpatient, nursing home, laboratory and medications; the community provided adult day care, home care, and transportation); and Model III involved VA case management with all services provided by the community. The objective of this study was to assess the impact of these models on patient outcomes.

Methods:
This was a non-equivalent control group program evaluation. Comparison group subjects received customary care. Veterans age 55 and older who met State nursing home eligibility criteria were enrolled. Veteran and caregiver functional and cognitive status and satisfaction with care were assessed every six months. Utilization and cost data were obtained from VA administrative data, community provider databases, and Medicare claims data. Site visits were conducted to assess program implementation.

Results:
Over two years, 686 veterans were enrolled into one of the pilot programs or comparison groups. Almost all participants were male with an average age of 75.7 years. Approximately one-third were impaired in activities of daily living at baseline (>2 impairments), while the percent cognitively impaired ranged from 26% in Model I to 60% in Model III. Veteran satisfaction with care improved in all three models over baseline. Caregiver satisfaction increased compared to comparison group caregivers whose satisfaction remained the same or declined. Use of any nursing home care at 12 months varied from 10% in Model I, 28% in Model II, and 42% in Model III. Time to placement for those who remained institutionalized ranged from 8 months in Model II, 10 months in Model III and 1 year in Model I. Inpatient hospital use was high, at 57%, 42%, and 58%, respectively for each model.

Implications:
Satisfaction with care increased, and permanent institutionalization was low following AIC enrollment regardless of model used while overall healthcare use was high. Implementation of each model elsewhere is dependent on the VA and community resources available at each site.

Impacts:
Frail elderly veterans utilize significant health care services. However, with adequate support, most can be maintained in the community.