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Who are Veterans newly admitted to nursing homes?

Intrator O, Miller E, Miller S, Guihan M, Meucci M, Hojlo C, Kinosian B. Who are Veterans newly admitted to nursing homes? Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 25; Baltimore, MD.




Abstract:

Research Objective: : Veterans can receive nursing home (NH) level care in Veterans Health Administration (VHA) owned Community Living Centers (CLCs) or VHA-paid or non-VHA-paid community NHs. This study examined characteristics of Veterans admitted to different types of NH settings, and how they changed between 2003 and 2009. Study Design: VHA data were merged with Medicare claims and the Minimum Data Set (MDS) to track veterans' use of VHA/non-VHA NH care. Four types of NH admissions were identified - CLCs, VA contracted NHs (CNHs), Medicare skilled nursing facilities (SNF), and non-VA general NHs that provide custodial care. We compared individual characteristics and admission sources (e.g. admitted from hospitals) for Veterans who were newly admitted to these four NH settings (i.e., with no NH stay in the prior 2 years) between 2005 and 2009. Population Studied: We identified 989,018 new NH admissions between 2005 and 2009, 105,262 (10.6%) were admitted to CLCs, 22,345 (2.3%) were admitted to CNHs, 177,245 (17.9%) were admitted to general NHs, and 684,166 (69.2%) were admitted to SNFs. Principal Findings: Overall, Veterans admitted to CLCs or CNHs were younger, more likely to be African-American and less likely to be physically impaired than those admitted to SNFs or general NHs. Veterans admitted to CLCs were more likely than Veterans admitted to all other settings to have cancer and a terminal diagnosis, have serious mental illness, and receive hospice care. The clinical profile of veterans admitted to NHs changed between 2005 and 2009. Compared to Veterans admitted to NHs in 2005, in 2009 Veterans were more likely to be functionally impaired (average ADL scores [on a 0-28 scale] increased from 8.8 to 10.3 in CLCs, and 14.8 to 16.7 in SNFs). Hospice care reported on the MDS increased in CLCs from 11.2% in 2005 to 19.1% in 2009. The proportion of Veterans with Congestive Heart Failure increased from 13.3% to 18.3% in CNHs, from 17.4% to 22.9% in general NHs, and from 22.6% to 26.3% in SNFs, while remaining around 12% in CLCs. Interestingly, the proportion of Veterans' admitted to NHs with dementia increased in SNFs, CNHs and general NHs (18.6% to 23.3%, 19.6% to 23.6%, and 22.1% to 26.1%, respectively) while it decreased slightly, from 11.2% to 10.2%, in CLCs. More surprisingly, the proportion of African-Americans increased from 13.1% to 16.3% in CLCs, while it decreased from 11.1% to 7.5% in all other NH settings. Conclusions: The profiles of Veteran receiving care in CLCs vs. other VA paid and non-VA paid NH settings appears quite different. It is important to elucidate the special roles CLC plays that lead to these differences. Implications for Policy, Delivery, or Practice: More global factors affecting quality of NH care for Veterans include VA initiatives to increase patient-centered care, improve effectiveness of discharge planning, provide care in the least restrictive environment and improving management of chronic conditions that might require re-hospitalization. Understanding the role of CLCs vis- -vis other NH settings is a critical step in improving long term care for Veterans.





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