VA Staff Perceptions of Barriers and Facilitators to Home-and Community-Based Placement Post-Hospital Discharge

Overview

Journal J Aging Soc Policy

Publisher Informa Healthcare

Specialty Geriatrics

Date 2018 Feb 23

PMID 29469672

Citations 4

Authors

Edward Alan Miller

Orna Intrator

Emily Gadbois

Stefanie Gidmark

James L Rudolph

Affiliations

Soon will be listed here.

Abstract

This study identifies factors U.S. Department of Veterans Affairs (VA) staff perceived to promote or impede home- and community-based services (HCBS) placement post-hospital discharge among Veterans cared for within the VA. Data derive from 35 semi-structured interviews with staff from 12 VA medical centers from around the country. VA staff reported that Veteran's care needs and social and financial resources influence HCBS placement. They also reported prerequisites for successful placement, including housing, unpaid informal care, and non-VA services funded privately and by public programs such as Medicaid and the Older Americans Act. Lack of staffing and failure to offer the specific types of services needed limit referral to and use of HCBS. Budgetary imperatives influence the relative availability of HCBS across VA medical centers. Findings highlight patient-, provider-, and system-level constraints that impede successful placement at home and in the community of Veterans in need of long-term services and supports after hospitalization.

Citing Articles

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References

Milliken A, Mahoney E, Mahoney K . "It just took the pressure off": The voices of Veterans' family caregivers in a participant-directed program. Home Health Care Serv Q. 2016; 35(3-4):123-136. DOI: 10.1080/01621424.2016.1227010. View

Shay K, Hyduke B, Burris J . Strategic plan for geriatrics and extended care in the veterans health administration: background, plan, and progress to date. J Am Geriatr Soc. 2013; 61(4):632-8. DOI: 10.1111/jgs.12165. View

Levy C, Alemi F, Williams A, Williams A, Wojtusiak J, Sutton B . Shared Homes as an Alternative to Nursing Home Care: Impact of VA's Medical Foster Home Program on Hospitalization. Gerontologist. 2015; 56(1):62-71. DOI: 10.1093/geront/gnv092. View

Kertesz S, Posner M, OConnell J, Swain S, Mullins A, Shwartz M . Post-hospital medical respite care and hospital readmission of homeless persons. J Prev Interv Community. 2009; 37(2):129-42. PMC: 2702998. DOI: 10.1080/10852350902735734. View

Costa A, Hirdes J . Clinical Characteristics and Service Needs of Alternate-Level-of-Care Patients Waiting for Long-Term Care in Ontario Hospitals. Healthc Policy. 2011; 6(1):32-46. PMC: 2929891. View

Lamanna D, Stergiopoulos V, Durbin J, OCampo P, Poremski D, Tepper J . Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions. Health Soc Care Community. 2017; 26(1):56-64. DOI: 10.1111/hsc.12461. View

Bardo A, Applebaum R, Kunkel S, Carpio E . Everyone's talking about it, but does it work? Nursing home diversion and transition. J Appl Gerontol. 2014; 33(2):207-26. DOI: 10.1177/0733464813505702. View

Thomas K, Allen S . Interagency partnership to deliver Veteran-Directed Home and Community-Based Services: Interviews with Aging and Disability Network agency personnel regarding their experience with partner Department of Veterans Affairs medical centers. J Rehabil Res Dev. 2016; 53(5):611-618. DOI: 10.1682/JRRD.2015.02.0019. View

Kramer B, Cote S, Lee D, Creekmur B, Saliba D . Barriers and facilitators to implementation of VA home-based primary care on American Indian reservations: a qualitative multi-case study. Implement Sci. 2017; 12(1):109. PMC: 5581481. DOI: 10.1186/s13012-017-0632-6. View

10.

Guihan M, Hedrick S, Miller S, Reder S . Improving the long-term care referral process: insights from patients and caregivers. Gerontol Geriatr Educ. 2011; 32(2):135-51. DOI: 10.1080/02701960.2011.572041. View

11.

Kane R . Finding the right level of posthospital care: "We didn't realize there was any other option for him". JAMA. 2011; 305(3):284-93. DOI: 10.1001/jama.2010.2015. View

12.

Garrido M, Allman R, Pizer S, Rudolph J, Thomas K, Sperber N . Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services. J Am Geriatr Soc. 2017; 65(11):2446-2451. PMC: 6317362. DOI: 10.1111/jgs.15053. View

13.

Sadowski L, Kee R, VanderWeele T, Buchanan D . Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA. 2009; 301(17):1771-8. DOI: 10.1001/jama.2009.561. View

14.

Robison J, Shugrue N, Porter M, Fortinsky R, Curry L . Transition from home care to nursing home: unmet needs in a home- and community-based program for older adults. J Aging Soc Policy. 2012; 24(3):251-70. DOI: 10.1080/08959420.2012.676315. View

15.

Stewart M, Felix H, Dockter N, Perry D, Morgan J . Program and policy issues affecting home and community-based long-term care use: findings from a qualitative study. Home Health Care Serv Q. 2006; 25(3-4):107-27. DOI: 10.1300/J027v25n03_07. View

16.

Chapin R, Chandran D, Sergeant J, Koenig T . Hospital to community transitions for adults: discharge planners and community service providers' perspectives. Soc Work Health Care. 2014; 53(4):311-29. DOI: 10.1080/00981389.2014.884037. View

17.

LeClerc C, Wells D, Craig D, Wilson J . Falling short of the mark: tales of life after hospital discharge. Clin Nurs Res. 2002; 11(3):242-63; discussion 264-6. DOI: 10.1177/10573802011003002. View

18.

Shay K, Burris J . Setting the stage for a new strategic plan for geriatrics and extended care in the Veterans Health Administration: summary of the 2008 VA State of the Art Conference, "The changing faces of geriatrics and extended care: meeting the needs of veterans.... J Am Geriatr Soc. 2008; 56(12):2330-9. DOI: 10.1111/j.1532-5415.2008.02079.x. View

19.

Ng T, Stone J, Harrington C . Medicaid home and community-based services: how consumer access is restricted by state policies. J Aging Soc Policy. 2014; 27(1):21-46. DOI: 10.1080/08959420.2015.969078. View

20.

Reder S, Hedrick S, Guihan M, Miller S . Barriers to home and community-based service referrals: the physician's role. Gerontol Geriatr Educ. 2009; 30(1):21-33. DOI: 10.1080/02701960802690241. View