Physicians May Need More Education about Long-Term Care Options for Veterans
The numbers of elderly Veterans will more than double to a total of 1.3 million by 2012, significantly straining existing resources and increasing the need for long-term care (LTC). Research on LTC preferences finds that most people who need it want to live as normally and independently as possible. Therefore, the defining values of LTC in VA, as stated in its LTC Strategic Plan, include caring for Veterans in the "least restrictive environment consistent with meeting a patient's needs." However, 92% of the 2.9 billion VA LTC dollars in FY 2005 was spent on nursing home care, thus VA has committed to a goal of tripling the proportion of home and community-based services (HCBS) within VA by 2013. The physician's role in referring Veterans to HCBS or institutional care is critical to achieving this goal. The purpose of this study was to obtain information about VA LTC referrals that could be used to develop interventions that increase the likelihood of referrals to HCBS instead of institutional care. Investigators collected information through interviews and focus groups from 86 study participants that included Veterans, informal caregivers, providers, administrators and managers, and social workers from five VA medical centers.
Findings indicate that physicians are often seen as having limited familiarity with HCBS options and tend to refer Veterans with LTC needs to nursing homes. Since physicians play an important leadership role on interdisciplinary teams and have considerable influence over the LTC choices made by Veterans and caregivers, the limited availability of LTC educational opportunities for physicians is of great concern. Training physicians about LTC referral options, with particular focus on how HCBS can be used to meet Veteran and caregiver needs, may help to increase those referrals.
Reder S, Hedrick S, Guihan M, and Miller S. Barriers to home and community-based service referrals: The physician’s role. Gerontology and Geriatrics Education February 2009;30(1):21-33.
This study was funded by HSR&D. Dr. Hedrick was part of HSR&D's Northwest Center for Outcomes Research in Older Adults when this research was conducted, and Dr. Guihan is part of HSR&D's Center for the Management of Complex Chronic Care.