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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3083 — Veterans in VA and Medicare Nursing Homes: Mental Health Service Need and Realized Access

Snow AL (Tuscaloosa VAMC and University of Alabama), Kunik ME (COE - Houston), Wei I (Centers for Medicare and Medicaid (CMS)), Yu HJ (COE - Houston), Morgan RO (COE - Houston)

Objectives:
To examine the mental health (MH) need and realized access of veterans residing in VA nursing homes (VANH) and Medicare-reimbursed nursing homes (MCNH).

Methods:
We examined veterans dually-enrolled in the VA and Medicare who had resided in either a VANH or a MCNH during the study period. We used Medicare (SNF and Carrier) and VA (XM and OPC) enrollment and utilization databases. MH diagnosis and procedure indicators were ICD-9 diagnostic codes and CPT codes, respectively. Contingency table analysis was used to examine differences in MH diagnoses and procedures across residence sites.

Results:
Of the final cohort of 340,184 veterans, 21% had lived only in a MCNH, 73% had lived only in a VANH, and 6% had lived in both. 153,664 (45.17%) had a MH diagnosis. The VANH only group had a higher diagnosis rate than the MCNH only group (49% versus 41%, respectively, p < = .001). Dual residers had the highest diagnosis rate (77%, p < = .001). Consistent with other studies of community and nursing home patients, depressive disorders were highly prevalent in all sites. Schizophrenia, PTSD, and substance abuse were more common in VANH. However, only a minority of the veterans with MH diagnoses received MH oriented care, with dual residers receiving the most MH procedures (VANH only = 23%; MCNH = 35%; Both = 48%; p < = .001). MH services were accessed through both VA and MC systems by a quarter of veterans who lived only in a VANH. Of veterans who lived only in a MCNH, a smaller but still substantial proportion accessed MH services through both systems (12%). Almost half of the dual residers accessed MH services through both systems.

Implications:
In 1987, federal legislation (Nursing Home Reform Act) mandated mental health care provision for nursing home residents. Yet, 20 years later, dually VA-Medicare enrolled veterans in nursing homes still exhibit significant unmet MH need, even despite access to two systems of care.

Impacts:
These results highlight the need for investigation of factors affecting receipt of MH care by veterans in nursing homes, such as the roles of system financing, provider availability, and models of care delivery.


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