Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1029 — Geriatrics & Extended Care Data Analysis Center Evaluation of the Impact of Personal Care Services on Costs of Veteran Care

Lead/Presenter: Orna Intrator, COIN - Providence
All Authors: Intrator O (GECDAC Canandaigua VAMC and University of Rochester) Kinosian B (GECDAC Philadelphia VAMC and University of Pennsylvania) Dally S (GECDAC-HERC Palo Alto VAMC) Hong J (GECDAC-HERC Palo Alto VAMC) Phibbs C (GECDAC-HERC Palo Alto VAMC and Stanford University) Edes TE (VA Center Office Geriatrics & Extended Care (10NC4)) Allman RA (VA Center Office Geriatrics & Extended Care (10P4G))

Objectives:
The Veterans Health Administration (VHA) Office of Geriatrics and Extended Care (GEC) cares for 6% of Veterans who account for 32% of VHA annual costs. GEC provides a continuum of services spanning outpatient and geriatric and long-term services and support programs to facility based long-term care and inpatient/ outpatient hospice and palliative care. We present an evaluation of the system-wide impact of VA Medical Center (VAMC) level penetration of personal care services (PCS: homemaker/home health aide, adult day care, or respite services) on subsequent nursing home stays > 90 days and costs of care among older frail Veterans.

Methods:
Data used included VHA provided and purchased care and Medicare utilization and costs data in fiscal years FY2007-2013. The impact of VAMC PCS penetration rate (%Veterans age 80+ with JEN Frailty Index (JFI) 3+ receiving PCS in the fiscal year) was tested on long-term institutionalization and costs among community dwelling Veterans in this high risk group using longitudinal Generalized Estimating Equations (negative binomial distribution with log link) clustered at VAMC and adjusting for Veteran characteristics.

Results:
Average PCS penetrations increased from 4.6% in 2007 to 8.5% in 2013 among Veterans age 80+ with JFI 3+. In 2013, Veteran Integrated Service Network (VISN) rates ranged between 6.4% and 11.1%. Among this population, a 1% higher PCS penetration above the average was associated with 2% lower relative risk of nursing home stays > 90 days and 0.55% lower total VHA + Medicare costs, or about $64.46 per Veteran per year (pvpy) but total average VHA costs were 1.2% higher ($63.35pvpy).

Implications:
System-wide outcomes go beyond specific program outcomes providing information that is important in communicating the need for investment in GEC services. We showed evidence of system-wide GEC penetration impact on frail Veterans. Although savings were not large, and were primarily evidenced in Medicare, their impact on Veterans' care outcomes is consistent with GEC's goal to honor Veterans' preferences by providing non-institutional services that reduce preventable institutional care.

Impacts:
VAMCs should consider prioritizing provision of GEC personal care services to frail elderly Veterans and better coordinating care provided by VA and Medicare.