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2015 HSR&D/QUERI National Conference Abstract

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3112 — A National Profile of Change in VA Community Living Centers 2004-2011

Allen SM, Providence VAMC; Cote DL, Providence VAMC; Wysocki A, Mathematica, Providence VAMC; Thomas K, Providence VAMC, Brown University; Intrator O, Canandaigua VAMC, University of Rochester; Youssef R, Providence VAMC; Kinosian B, Philadelphia VAMC; Phibbs C, Palo Alto VA, HERC; Mor V, Providence VAMC, Brown University;

Objectives:
The Millennium Act of 1999 called for a shift in Veterans' long term care from institutions to the community. The objective of this research is to describe change in Community Living Centers (CLCs) from 2004-2011 in response to VA mandates to discharge patients to the community with home and community based services (HCBS) as soon as treatment goals are met.

Methods:
We created a database of aggregate measures to describe trends in the characteristics of CLCs and their patients using the VHA Managerial Cost Accounting System (MCA) the Patient Treatment File (PTF), and the VA Minimum Data Set (MDS 2.0). For each year (2004-2011), we calculated the average distribution of types of stay (short stay ( < = 90 days), long stay ( > 90 days), and hospice); the average length of stay (LOS), and the average distribution of discharge destinations (to hospital, nursing home, or community) by type of stay for each of 134 VA CLCs nationally. We present the overall average for all CLCs, using a linear test for trend to test for differences over time.

Results:
Moderate decreases in the average proportion of patients with short stays (68.3% to 61.0%) and long stays (21.9% to 16.4%) from 2004-2011 were observed. Additionally, the proportion of patients with a hospice stay increased from 9.8% to 22.5% (p < .001). The average LOS in CLCs for all stays decreased considerably over the study period (from 148.8 days to 96.5 days). Notably, LOS for long stay patients decreased from 459.7 days to 381.9 days (p < .001). A significant increase in the proportion of patients discharged to the community was observed over the study period for both short stay patients (71.9% to 81.0%; p < .001) and for long stay patients (48.9% to 73.5%; p < .001).

Implications:
This national profile of change in VA CLCs from 2004-2011 suggests that VA mandates for timely discharge to community settings have had an impact. Additionally, CLCs appear to be one locus of care that has expanded Veterans' access to hospice.

Impacts:
Timely discharge of Veterans from VA CLCs to the community can expand access to HCBS, which may decrease the need for permanent nursing home placement.