Long-term care (LTC) can be defined as the range of institutional and home and community-based services that support individuals needing chronic care. VA faces an increasing demand for these services with the growing number of Veterans 85 and older, those most in need of LTC. The decision about where to refer older Veterans is critical, as a mismatch between a LTC program and a person's needs and preferences can have an enormous impact on quality of care and life. In order to identify best practices for LTC referral systems, outcomes of interest were in place with the exception of two important outcomes, satisfaction with the referral process and cost.
The objectives of this study were to develop and test those measures needed to assess LTC referral models: (1) Patient, family caregiver and provider satisfaction with the LTC referral process, and (2) Process and cost of LTC referrals.
Three VAMCs in VISN 11 - Battle Creek, Ann Arbor and Detroit are the study settings. The Geriatrics and Extended Care (GEC) Referral Form is being used to obtain samples of LTC referrals including the referred patients, their informal This study took place at three VA Medical Centers in Michigan - Detroit, Ann Arbor and Battle Creek - which represented three different models of LTC referral. The steps involved in the development of the satisfaction measures included: (1)developing a pool of potential satisfaction items, (2) refinement of items through readability testing and cognitive interviews, (3) pilot testing, (4) full scale field testing, and (5) and documentation of final items. The steps involved in the development of the cost measures included: (1) cataloguing of the LTC referral process and the resources used in that process, (2) developing a method for estimating the use of resources in the LTC referral process, (3) collecting data to estimate the use of resources.
We successfully developed measures for evaluating satisfaction and made important steps in understanding and developing measures of the cost of LTC referrals. We developed Veteran, family caregiver, medical provider and LTC provider instruments for evaluating satisfaction with LTC referrals. For the cost measure, we developed a questionnaire and process for assessing the cost of LTC staff involved in LTC referrals, and a process for assessing the cost of a LTC committee. When a LTC committee is not used, a patient-specific method of assessing costs needs further development. We also found that existing LTC referral models may need to be revisited, as the models were not as clearly differentiated as our initial research indicated. Finally, given that the Geriatric and Extended Care referral form is no longer used nationally, it should be a priority to ensure that another process for collecting data on LTC referrals is put in place.
The newly developed cost and satisfaction measures, in conjunction with existing methods for measuring other aspects of the LTC referral process (e.g., health outcomes, quality of life), will be of value for a national evaluation of LTC referral models, as well as for program specific evaluations of the LTC referral system. Older Veterans will benefit from identification and implementation of best practices for LTC referral.
None at this time.
Aging, Older Veterans' Health and Care, Health Systems
Cost, Long-term care, Satisfaction (patient)