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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3055 — Discharge Outcomes among Veterans Substituting Medical Foster Home Care for Nursing Home Placement

Levy CR, Denver REAP;

Objectives:
The Medical Foster Home (MFH) program is a rapidly expanding VA alternative to nursing home (NH) placement for Veterans who are NH-eligible but prefer to receive care in a private home. Veterans assume room and board charges ranging from $1500-3000 monthly paid directly to the MFH caregiver and Home Based Primary Care coordinates all medical care in the MFH. The objective of this study was to assess discharge outcomes in the MFH program following the 2008 “Support at Home – Where Heroes Meet Angels” initiative, which added 52 MFH Programs to the existing 3 programs nationally.

Methods:
Data were obtained from the MFH Monthly Workload Report maintained by the Office of Geriatrics and Extended Care, Home and Community Based Care.

Results:
Among enrollees, September 2010 through August 2011, 210 Veterans were discharged with mean and median length of stay of 220 and 115 days, respectively. One in four Veterans (24%) were Priority 1A. A total of 41.4% (N = 87) of discharges were due to death, and among decedents, 60.8% (N = 53) died in the MFH; the remaining Veterans died in a hospital. Of those discharged alive (N = 123), 23.6% (N = 29) were admitted to a hospital, 14.6% (N = 18) were admitted to a nursing home, and 59.3% were discharged home with family members (N = 40) or to an assisted living facility (N = 33).

Implications:
The majority of Veterans remained in the MFH until death, transitioned to a less restrictive care setting or home with family; fewer than 15% required NH placement. One in four Veterans were Priority 1A and would otherwise reside in a VA Community Living Center or a Contract Nursing Home with VA, rather than the Veteran, paying room and board monthly costs ranging from $6,960-$25,830. With average length of stay in a MFH of 7 months, this may represent significant cost savings for VA.

Impacts:
MFH has the potential to provide a viable alternative to NH placement for Veterans who prefer care in a private home rather than a NH.


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