Purchasing High-Quality Community Nursing Home Care: A Will to Work With VHA Diminished by Contracting Burdens

Magid, Kate H; Galenbeck, Emily; Haverhals, Leah M.; Cornell, Portia; Moyo, Patience; Mochel, Amy L; Corneau, Emily; Rudolph, James L.; Mor, Vincent; Levy, Cari

doi:10.1016/j.jamda.2022.03.007

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Since 1965, VA has paid for eligible Veterans' care in CNHs. The VA CNH program team, comprised of nurses, social workers, program coordinators, and other licensed team members, is responsible for oversight of the Veteran's care 19,20 . Within 30 days of CNH placement, the local VA CNH program field staff (nurses and social workers) complete an in‐person visit with the Veteran to assist with the Veteran's transition to the facility.…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…The VA CNH program team, comprised of nurses, social workers, program coordinators, and other licensed team members, is responsible for oversight of the Veteran's care. 19,20 Within 30 days of CNH placement, the local VA CNH program field staff (nurses and social workers) complete an in-person visit with the Veteran to assist with the Veteran's transition to the facility. Every 30 to 45 days thereafter, the registered nurse and social worker alternately complete in-person visits to monitor the Veteran's condition and ensure care needs are being met.…”

Section: Va Cnh Programmentioning

confidence: 99%

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Barriers and facilitators to goals of care conversations with Veteran residents of community nursing homes

Keddem

Ayele

Ersek

et al. 2023

J American Geriatrics Society

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Background Despite evidence that structured goals of care conversations (GoCCs) and documentation of life‐sustaining treatment (LST) preferences improve the delivery of goal‐concordant care for seriously ill patients, rates of completion remain low among nursing home residents. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision‐Making (PERSIVED) program aims to improve the consistent documentation of LST preferences among Veterans receiving care in veterans affairs (VA)‐paid community nursing homes (CNH); however, the barriers and facilitators of completing and documenting GoCCs in this unique context of care have not been described. Methods We conducted semi‐structured, qualitative interviews with key stakeholders of the VA CNH programs located at six VA Medical Centers between July 2021 and July 2022. With a rapid approach to analysis, interview transcripts were reduced into memo templates using the Tailored Implementation for Chronic Disease Checklist and coded and analyzed using qualitative data analysis software. Results The 40 participants consisted of nurses (n = 13), social workers (n = 25), and VA physicians (n = 2). Most participants felt confident about conducting GoCC; however, several barriers were identified. At the staff level, our results indicated inconsistent completion of GoCC and documentation due to a lack of training, confusion about roles and responsibilities, and challenging communication within the VA as well as with CNH. At the organizational level, there was a lack of standardization across sites for how LST preferences were documented. At the patient level, we found key barriers related to patient and family readiness and issues finding surrogate decision makers. While COVID‐19 brought end‐of‐life issues to the forefront, lockdowns hindered communication about the goals of care. Conclusion Findings from this pre‐implementation evaluation revealed multi‐level barriers in conducting and documenting GoCCs with Veterans receiving VA‐paid CNH care, as well as several facilitators that can be used to inform strategies for improvement.

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Section: Study Data and Methodsmentioning

confidence: 99%

Section: Va Cnh Programmentioning

confidence: 99%

Barriers and facilitators to goals of care conversations with Veteran residents of community nursing homes

Keddem

Ayele

Ersek

et al. 2023

J American Geriatrics Society

View full text Add to dashboard Cite

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“…This study was a component of a larger research project examining VA-purchased CNH care; recruitment methods are available in previous publications describing this work. 7 Participants provided written or verbal consent before video and phone interviews, respectively. This study was approved by the Colorado Multiple Institutional Review Board (Protocol # .…”

Section: Methodsmentioning

confidence: 99%

Community Nursing Home Program Oversight: Can the VA Meet Increased Demand for Community-Based Care?

Levy

2023

Federal Practitioner

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Background: The US Department of Veterans Affairs (VA) Community Nursing Home (CNH) program provides inperson oversight monitoring the quality of care of veterans in VA-contracted community-based skilled nursing homes. The number of veterans receiving CNH care is projected to increase by 80% by 2037. Methods: Retrospective observational data describing the distance between contracted facilities and VA medical centers (VAMCs) were linked to Centers for Medicare and Medicaid monthly Nursing Home Compare and Brown University Long Term Care: Facts on Care in the US data. Qualitative interviews with CNH-based staff and VA-based CNH program oversight team members were conducted using a semistructured interview guide. Quantitative and qualitative data were analyzed independently and integrated during the interpretation of results. Results: The number of CNHs per VAMC ranged from 1 to 68 (mean, 18). One in 4 CNHs were > 70 miles from the associated VAMC; among CNHs with 2 to 5 veterans, 44% were located > 50 miles away. Four qualitative themes emerged regarding VA CNH oversight: (1) benefits of VA CNH team engagement/ visits, including quality assurance and care coordination;(2) burden of VA CNH oversight due to geographic dispersion with too few or too many veterans at each to achieve efficiency; (3) oversight burdens and limited staffing restricted ability to add CNHs; and (4) remote access and interoperability of electronic health records and balancing the number of CNH veterans with staffing could facilitate successful oversight. Conclusions: The success of the CNH program will depend on the exchange of information and matching available resources to veterans' needs. At a time when strategies to ease the burden on NHs and VA CNH coordinators are needed, the VA needs to improve to properly scale the program.

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Quality Improvement Efforts in VA Community Living Centers Following Public Reporting of Performance

Davila

Mills

Clark

et al. 2023

Journal of Aging & Social Policy

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Purchasing High-Quality Community Nursing Home Care: A Will to Work With VHA Diminished by Contracting Burdens

Cited by 3 publications

References 12 publications

Barriers and facilitators to goals of care conversations with Veteran residents of community nursing homes

Barriers and facilitators to goals of care conversations with Veteran residents of community nursing homes

Community Nursing Home Program Oversight: Can the VA Meet Increased Demand for Community-Based Care?

Quality Improvement Efforts in VA Community Living Centers Following Public Reporting of Performance

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