Community-based residential care for the minimally impaired elderly: a survey analysis

Medical foster home is less costly than traditional nursing home care

OBJECTIVE

To compare the costs of Community Nursing Homes (CNHs) to Medical Foster Homes (MFHs) at Veteran Health Administration (VHA) Medical Centers that established MFH programs.

DATA SOURCES

Episode and costs data were derived from VA and Medicare files (inpatient, outpatient, emergency room, skilled nursing facility, dialysis, and hospice).

STUDY DESIGN

Propensity scores matched 354 MFH to 1693 CNH Veterans on demographics, clinical characteristics, health care utilization, and costs.

DATA EXTRACTION METHODS

Data were retrieved for years 2010-2011 from the VA Corporate Data Warehouse, VA Health Data Repository, and the VA MFH Program through the VA Informatics and Computing Infrastructure (VINCI).

PRINCIPAL FINDINGS

After matching on unique characteristics of MFH Veterans, costs were $71.28 less per day alive compared to CNH care. Home-based and mental health care costs increased with savings largely attributable to avoiding CNH residential care. When average out-of-pocket payments by Veterans of $74/day are considered, MFH is at least cost neutral. Mortality was 12 percent higher among matched Veterans in CNHs.

CONCLUSIONS

MFHs may serve as alternatives to traditional CNH care that do not increase total costs with mortality benefits. Future work should examine the differences for functional disability subgroups.

Shared Homes as an Alternative to Nursing Home Care: Impact of VA's Medical Foster Home Program on Hospitalization

PURPOSE OF THE STUDY

This study compares hospitalization rates for common conditions in the Veteran Affairs (VA) Medical Foster Home (MFH) program to VA nursing homes, known as Community Living Centers (CLCs).

DESIGN AND METHODS

We used a nested, matched, case control design. We examined 817 MFH residents and matched each to 3 CLC residents selected from a pool of 325,031. CLC and MFH cases were matched on (a) baseline time period, (b) follow-up time period, (c) age, (d) gender, (e) race, (f) risk of mortality calculated from comorbidities, and (g) history of hospitalization for the selected condition during the baseline period. Odds ratio (OR) and related confidence interval (CI) were calculated to contrast MFH cases and matched CLC controls.

RESULTS

Compared with matched CLC cases, MFH residents were less likely to be hospitalized for adverse care events, (OR = 0.13, 95% CI = 0.03-0.53), anxiety disorders (OR = 0.52, 95% CI = 0.33-0.80), mood disorders (OR = 0.57, 95% CI = 0.42-0.79), skin infections (OR = 0.22, 95% CI = 0.10-0.51), pressure ulcers (OR = 0.22, 95% CI = 0.09-0.50) and bacterial infections other than tuberculosis or septicemia (OR = 0.54, 95% CI = 0.31-0.92). MFH cases and matched CLC controls did not differ in rates of urinary tract infections, pneumonia, septicemia, suicide/self-injury, falls, other injury besides falls, history of injury, delirium/dementia/cognitive impairments, or adverse drug events. Hospitalization rates were not higher for any conditions studied in the MFH cohort compared with the CLC cohort.

IMPLICATIONS

MFH participants had the same or lower rates of hospitalizations for conditions examined compared with CLC controls suggesting that noninstitutional care by a nonfamilial caregiver does not increase hospitalization rates for common medical conditions.

A qualitative evaluation of a new community living model: medical foster home placement

Background

The Department of Veterans Affairs (VA) Medical Foster Home (MFH) program is an alternative to nursing home (NH) placement for veterans who are NH-eligible but prefer to receive care in private homes. Program expansion is ongoing; however, inefficiencies exist in targeting Veterans for enrollment.

Methods

Semi-structured interviews were conducted with 35 individuals, 9 national MFH coordinators, 14 Primary Care Team Members, 2 veterans living in MFHs, 4 of their family members, 3 caregivers, and 3 family members of veterans who declined to participate in the program. Transcripts were analyzed using a general inductive approach supported by Archive for Technology, Lifeworld and Everyday language, text interpretation (ATLAS ti) V6.2.

Results

Three themes were identified as key facilitators of successful MFH placement: 1) The Environment - veterans needed to have appropriate and comfortable physical space that ensured safety and was in a desirable geographic location; 2) The Match - a collaborative relationship between veterans, care providers, and the medical team providing care within the home was essential; and 3) Perceptions and Expectations about the ability for needs to be met in MFHs and challenges related to health concerns, relocation, and costs. These themes, when integrated into the Social Ecological Model, provide a theoretical framework from which to guide future research and understand policy implications.

Conclusions

MFHs represent a novel alternative to NH placement. This evaluation provides an understanding of factors that lead to successful MFH placement and integrates these themes into a theoretical framework designed to assist both VA policymakers interested in expanding the program and those within the civilian community seeking to study alternatives to traditional NH care.