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ABSTRACT
Little is known about how the extended care referral process—its structure and participants—influences Veterans’ use of home and community-based services (HCBS) over nursing home care within the Veterans Health Administration (VHA). This study thus characterizes the extended care referral process within the VHA and its impact on HCBS versus nursing home use at hospital discharge. Data derive from 35 semistructured interviews at 12 Veterans Affairs Medical Centers (VAMCs). Findings indicate that the referral process is characterized by a commitment by care teams to consider HCBS if possible, varied practice depending on the clinician that most heavily influences care team recommendations, and care team emphasis on respecting Veteran/family preferences even when they are contrary to care team recommendations. Potential modifications include adopting systematic assessment practices; improving Veteran, family, and provider education; and promoting informed selection through shared decision making.
Acknowledgments
The authors would like to acknowledge insightful comments from Marianne Shaughnessy from the Office of Geriatrics & Extended Care on an earlier version of this manuscript. The authors would also like to acknowledge Kimberly Kelly, also from the Office of Geriatrics & Extended Care, who reviewed the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
Funding
This study is based upon work supported in part by the Department of Veterans Affairs, including a Health Services Research & Development Grant IAD-07-106 to Dr. Intrator. Dr. Rudolph and Dr. Intrator are supported by the VA Health Services Research and Development Center of Innovation in Long-Term Services and Supports (CIN 13-419) and the VA QUERI-Geriatrics and Extended Care Partnered Evaluation Center for Community Nursing Homes (PEC 15-465).