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

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.

KEYWORDS:

• Veterans Affairs
• home- and community-based services
• nursing homes
• long-term care
• qualitative interviews
• hospital discharge planning

Acknowledgments

The authors would like to acknowledge insightful comments from Kimberly Kelly, Dayna Cooper, and Marianne Shaughnessy from the Office of Geriatrics & Extended Care Services. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the United States Department of Veterans Affairs or the United States government.

Additional information

Funding

This work is supported in part by the U.S. Department of Veterans Affairs, including a Health Services Research & Development grant (IAD-07-106) to Orna Intrator. James Rudolph and Orna Intrator are also 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).