Spotlight: Research into Long-Term Care
June 2013
Care for a short-term health concern is typically a finite process: A patient is admitted to a hospital, or has treatment within a physician's office, and
recovers from the condition or acute health event. However, some people face health concerns that require care for months, years, or, in some cases, the
rest of their lives. That kind of care is known as long-term care (LTC), and it can include
a range of services and supports that meet an individual's needs over a long period of time.
In general, most LTC does not take the form of medical treatment, but instead, is comprised of the basic tasks of everyday life, or activities of daily
living (ADL). These activities may include bathing, dressing, using the toilet, eating, or moving from place to place—such as from a bed to a chair. Other
common LTC assistance may take the form of important, everyday tasks (known as instrumental activities of daily living, or IADLs), such as housework, money
management, grocery shopping and meal preparation, or even caring for pets.
Estimates show that approximately 800,000 Veterans enrolled in VA healthcare depend on assistance with at least one ADL. By 2020, more than 700,000 Veterans
enrolled in VA healthcare will be over the age of 85, and most will require some kind of assistance with at least one ADL. And, while LTC support is
predominantly associated with aging, Veterans of any age can require LTC services, with those wounded in combat of special concern for comprehensive LTC
services.
The VA's Office of Geriatrics and Extended Care (GEC) oversees VA's programs to provide both geriatric and long-term care programs and services to
Veterans. Further, investigators within VA's Health Services Research & Development Service (VA HSR&D) conduct a body of research into the
delivery, effectiveness, and value of LTC services. Part of this research includes partnerships with the VA GEC to ensure that valuable research questions
are being addressed, and that study results will be quickly implemented into practice.
LTC Research Projects
HSR&D recently funded the Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) initiative. One project within the CREATE initiative focuses specifically on LTC. Through partnerships with the VA Office of GEC, this project, "Long Term Care," will
conduct research to provide tools, evidence, and evaluation information necessary for GEC policymakers and staff within the VA healthcare system to
transform the spectrum of LTC services.
There are three studies within the LTC initiative:
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Evaluating Implementation of the Medical Foster Home (MFH) . The MFH program serves as a VA alternative to nursing home placement for Veterans who are nursing home-eligible but prefer to receive care in a
private home with qualified caregivers. This project will examine characteristics of Veterans served in MFHs, and how they differ from Veterans
residing in NHs.
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Reducing Veterans' Hospitalizations from Community Living Centers (CLCs)
. Investigators will implement and evaluate the INTERACT program, which is designed to reduce the rate of hospitalization of Community Living Center
residents by focusing on nurse-physician communication.
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Increasing Veterans' Use of Community-Based LTC via Timely Discharge from VA CLCs.
This project seeks to evaluate the impact of recent GEC initiativesintended to reduce the length of CLC stays, as well as readmission
rates.
Other recent VA HSR&D studies focusing on LTC include:
Access to nursing home care.
VA provides nursing home care to approximately 85,000 Veterans through a mix of facilities. Some Veterans receive care from one of VA's 134 CLCs, while
others are cared for in community nursing homes on contract with the VA. State Veterans Homes paid by the VA also provide LTC for Veterans. In this
currently ongoing study, investigators expect to provide VA with critical information about meeting the LTC needs of aging Veterans through data that
show where Veterans receive nursing home care and what factors relate to admissions, transitions, and length of stay.
Infection prevention in Community Living Centers (CLCs). For those Veterans receiving LTC services in a VA CLC, preventing transmission of bacteria such as methicillin-resistant S. aureus (MRSA), is
critical. While sterile gowns, gloves, and regular hand-washing will prevent MRSA transmission, using them takes away from a patient-centered,
home-like environment—an important priority within the VA CLC environment. This study will look at ways to identify patient care activities that most
likely to lead to MRSA transmission. Investigators expect results to offer evidence about prioritizing when disposable gowns and gloves should be worn,
or when hand washing should be emphasized.
Understanding the needs of informal caregivers. Completed in 2011, this study looked at the physical, emotional, and financial burdens of caregiving on "informal" caregivers (usually family or
friends), and tried to determine what resources are available to those caregivers. Study results showed that caregivers were primarily women (79%), and
typically a parent (62%) or spouse (32%). A median four years after injury, 22% of Veterans still required assistance with activities of daily living
(ADLs) and independent activities of daily living (IADLS). An additional 48% required assistance with only IADLs. Most caregivers also reported
providing other kinds of care, including managing emotions and navigating health and legal systems, and financial strain was common among all
caregivers, with 62% reported depleted assets and/or accumulated debt.
Note
During the course of this study, the Caregivers and Veterans Omnibus Health Services Act of 2010, which is intended to provide benefits to caregivers
in order to curb the strain associated with caregiving, was passed. Data from this study provide a baseline assessment of what caregiving demands were
prior to the law's enactment, and identify potential areas for future intervention to reduce caregiver burden and improve care recipient community
integration.
