scholarly journals P4-388: PREVENTING LOSS OF INDEPENDENCE THROUGH EXERCISE (PLIÉ): IMPLEMENTATION AT A VETERANS HEALTH ADMINISTRATION COMMUNITY LIVING CENTER/NURSING HOME

2019 ◽  
Vol 15 ◽  
pp. P1449-P1449
Author(s):  
Jennifer Lee ◽  
Lynn Martin ◽  
Maria Lee ◽  
Deborah E. Barnes
Keyword(s):  
Nursing Home ◽  
Veterans Health Administration ◽  
Community Living ◽  
Veterans Health ◽  
Health Administration

scholarly journals Nursing Home Referral Within the Veterans Health Administration: Practice Variation by Payment Source and Facility Type

2017 ◽  
Vol 40 (7) ◽  
pp. 687-711
Author(s):  
Edward Alan Miller ◽  
Stefanie Gidmark ◽  
Emily Gadbois ◽  
James L. Rudolph ◽  
Orna Intrator
Keyword(s):  
Nursing Home ◽  
Discharge Planning ◽  
Veterans Health Administration ◽  
Practice Variation ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Staff Perceptions ◽  
Medical Centers ◽  
Community Living Centers

Veterans enrolled within the Veterans Health Administration (VHA) of the U.S. Department of Veterans Affairs (VA) may receive nursing home (NH) care in VHA-operated Community Living Centers (CLCs), State Veterans Homes (SVHs), or community NHs, which may or may not be under contract with the VHA. This study examined VHA staff perceptions of how Veterans’ eligibility for VA and other payment impacts NH referrals within VA Medical Centers (VAMCs). Thirty-five semistructured interviews were performed with discharge planning and contracting staff from 12 VAMCs from around the country. VA staff highlights the preeminent role that VA priority status played in determining placement in VA-paid NH care. VHA staff reported that Veterans’ placement in a CLC, community NH, or SVH was contingent, in part, on potential payment source (VA, Medicare, Medicaid, and other) and anticipated length of stay. They also reported that variation in Veteran referral to VA-paid NH care across VAMCs derived, in part, from differences in local and regional policies and markets. Implications for NH referral within the VHA are drawn.

Abstract W P296: Care Trajectories and Costs after Ischemic Stroke for Patients in the Veterans Health Administration

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Greg Arling ◽  
Susan Ofner ◽  
Laura Meyers ◽  
Joanne Daggy ◽  
Mat Reeves ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Nursing Home ◽  
Home Care ◽  
Care Home ◽  
Veterans Health Administration ◽  
Nursing Home Care ◽  
Rehabilitation Services ◽  
Veterans Health ◽  
Health Administration

Background: Patients vary greatly in their use of care after hospitalization for stroke. We classified stroke patients according to their care trajectories and associated costs in the 12-month period after hospital discharge. Methods: We followed a cohort of 3,811 veterans for one year after hospitalization with ischemic stroke in Veterans Health Administration facilities in 2007. Three discharge outcomes -- nursing home care, home care, and mortality -- were modeled jointly with Latent Class Growth Analysis. VA and Medicare costs were obtained for use of institutional care (inpatient acute, rehabilitation facility, and nursing home) and home care (home health, other home care, and outpatient rehabilitation). Covariates included patient age, NIHSS stroke severity and FIM scores measured at hospital discharge. Results: Members of the cohort had one of five care trajectories: 49% had a Rapid Recovery with little or no use of care in the 12 months after discharge, 15% had a Gradual Recovery with initially high nursing or home care use that tapered off over time, 9% had consistent use of Long-Term Home Care (HC), 13% had consistent use of Long-Term Nursing Home Care (NH), and 14% had an Unstable trajectory with multiple transitions between long-term and acute care. Patients with Long-Term NH and Unstable trajectories had the highest average total costs (greater than $60,000 per person) and patients with the Rapid Recovery trajectory had the lowest cost (less than $11,000 per person). Medicare accounted for 23% of total costs. In a multinomial regression model, the likelihood of a Long-Term NH, Long-Term HC or an Unstable Trajectory was greatest for persons with more severe strokes (higher NIHSS score), more disability (lower FIM score), and age 65 or older. About half of the veterans received rehabilitation services. Most rehabilitation was delivered in the NH. There was no clear association between use of rehabilitation and subsequent care trajectory. Conclusions: Care trajectories were explained partly by veteran health and functional status. However, we need a better understanding of system factors shaping care trajectories, particularly access to and use of rehabilitation services.

scholarly journals Is Variation in Resident-Centered Care and Quality Performance Related to Health System Factors in Veterans Health Administration Nursing Homes?

2018 ◽  
Vol 55 ◽  
pp. 004695801878703 ◽  
Author(s):  
Jennifer L. Sullivan ◽  
Ryann L. Engle ◽  
Denise Tyler ◽  
Melissa K. Afable ◽  
Katelyn Gormley ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Health System ◽  
Veterans Health Administration ◽  
Community Living ◽  
Veterans Health ◽  
Health Administration ◽  
Staff Members ◽  
Centered Care ◽  
Community Living Centers ◽  
System Factors

The purpose of this research was to explore and compare common health system factors for 5 Community Living Centers (ie Veterans Health Administration nursing homes) with high performance on both resident-centered care and clinical quality and for 5 Community Living Centers (CLC) with low performance on both resident-centered care and quality. In particular, we were interested in “how” and “why” some Community Living Centers were able to deliver high levels of resident-centered care and high quality of care, whereas others did not demonstrate this ability. Sites were identified based on their rankings on a composite quality measure calculated from 28 Minimum Data Set version 2.0 quality indicators and a resident-centered care summary score calculated from 6 domains of the Artifacts of Culture Change Tool. Data were from fiscal years 2009-2012. We selected high- and low-performing sites on quality and resident-centered care and conducted 12 in-person site visits in 2014-2015. We used systematic content analysis to code interview transcripts for a priori and emergent health system factor domains. We then assessed variations in these domains across high and low performers using cross-site summaries and matrixes. Our final sample included 108 staff members at 10 Veterans Health Administration CLCs. Staff members included senior leaders, middle managers, and frontline employees. Of the health system factors identified, high and low performers varied in 5 domains, including leadership support, organizational culture, teamwork and communication, resident-centered care recognition and awards, and resident-centered care training. Organizations must recognize that making improvements in the factors identified in this article will require dedicated resources from leaders and support from staff throughout the organization.

scholarly journals Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration

2017 ◽  
Vol 58 (4) ◽  
pp. e226-e238 ◽  
Author(s):  
Edward Alan Miller ◽  
Stefanie Gidmark ◽  
Emily Gadbois ◽  
James L Rudolph ◽  
Orna Intrator
Keyword(s):  
Nursing Home ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Key Factors ◽  
Staff Perceptions ◽  
Search And Selection
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