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|Issue 156||July 2019|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Review: Risk Factors and Interventions to Prevent or Delay Long-term Nursing Home Placement for Adults with Impairments
In fiscal year 2020, VA is projected to spend $9.8 billion on long-term care services for eligible Veterans. Recent legislation also has created and expanded VA programs to support informal caregivers (i.e., family or friends who provide unpaid care for Veterans with substantial impairments). In 2017, the VA Secretary launched the Choose Home Initiative to enhance VA policies and practices for supporting Veterans and their informal caregivers—and to improve collaboration with non-VA community groups — thereby helping Veterans with significant impairments remain in community settings, if they choose. To help VA policymakers understand the effects of VA-provided or VA-funded home and community-based services (HCBS), particularly in avoiding long-term nursing home placement (NHP), the VA Evidence Synthesis Program was asked to examine evidence on modifiable risk factors for long-term nursing home placement and interventions that aim to delay long-term NHP for community-dwelling adults with physical and/or cognitive impairments.
Investigators with VA's Evidence Synthesis Program in Minneapolis, MN searched for systematic reviews in multiple databases, including: MEDLINE, Sociological Abstracts, PsycINFO, CINAHL, Embase, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database, Agency for Healthcare Research and Quality Evidence-based Practice Center and VA ESP reports. They screened 7,014 unique citations for systematic reviews and reviewed the full text of 336 articles, identifying 67 eligible systematic reviews, which mainly addressed older adults and/or those with dementia. Articles were included if review authors clearly intended to examine long-term NHP as an outcome of interest. Investigators found no eligible reviews that addressed long-term NHP for individuals with PTSD and/or traumatic brain injury (TBI).
Summary of Review
Additional key findings:
Additionally, VA facilities differ in the number and types of long-term care programs and services that are provided and/or funded. Understanding what is available at a particular VA facility – and coordinating services across multiple VA programs at the same facility – remain key challenges for Veterans, their caregivers, and VA clinical staff. Therefore, case management for Veterans with impairments may offer substantial benefits, despite the lack of effectiveness in general, as suggested by review results. To impact long-term NHP, case management (and other similar interventions) should have relatively high-frequency longitudinal contacts with participants, be initiated early in the course of chronic conditions (e.g., dementia), and extend for at least several years.
More specific suggestions include:
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Related HSR&D Research Topics:
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
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