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Thomas KS, Corneau E, Gidmark S, Rickard T, Allen S. VARIABILITY IN ACCESS TO VA’S AID AND ATTENDANCE PENSION BENEFIT: A MIXED-METHODS STUDY. Innov Aging 2019. [PMCID: PMC6841530 DOI: 10.1093/geroni/igz038.2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Veterans Benefit Administration’s (VBA) Aid and Attendance enhanced pension benefit (A&A) is available to older, low-income Veterans who require assistance meeting their daily needs. However, reports indicate that A&A is underutilized with only 1/3 of eligible Veterans receiving this benefit. The objective of this mixed methods study is to characterize the variability in A&A enrollment across VA Medical Centers (VAMCs) and determine factors attributable to the variation. Using VA administrative data, we calculated the rate of enrollment in A&A among Veterans receiving pension. We then purposefully sampled 16 Chiefs of Social Work at VAMCs with the highest (n=7) and lowest (n=9) rates of enrollment. Interviews were transcribed, coded, and analyzed using conventional qualitative research methods. The rate of enrollment in A&A varies from <1% to 23% across VAMCs. VAMCs that had higher rates of enrollment were larger and more likely to be located in the South and Mid-Atlantic regions. Respondents at sites with low rates of enrollment indicate that education around the eligibility criteria is needed for VAMC staff. They also report that outreach to Veterans about this benefit is limited. Respondents at VAMCs with high rates of enrollment indicate that the relationships with VBA and Veterans Service Organizations facilitates access. Universally, respondents viewed the A&A benefit positively and note that it helps meet Veterans’ long-term care needs. As the Veteran population continues to age, it is important that VA ensure equal access to A&A for eligible Veterans. Implications of these findings and next steps will be discussed.
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Affiliation(s)
- Kali S Thomas
- Providence VA Medical Center, Providence, Rhode Island, United States
| | - Emily Corneau
- Providence VA Medical Center, Providence, Rhode Island, United States
| | - Stefanie Gidmark
- Providence VA Medical Center, Providence, Rhode Island, United States
| | - Taylor Rickard
- Providence VA Medical Center, Providence, Rhode Island, United States
| | - Susan Allen
- Brown School of Public Health, Providence, Rhode Island, United States
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Sullivan JL, Weinburg DB, Gidmark S, Engle RL, Parker VA, Tyler DA. Collaborative capacity and patient-centered care in the Veterans' Health Administration Community Living Centers. Int J Care Coord 2019; 22:90-99. [PMID: 32670596 DOI: 10.1177/2053434519858028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Previous research in acute care settings has shown that collaborative capacity, defined as the way providers collaborate as equal team members, can be improved by the ways in which an organization supports its staff and teams. This observational cross-sectional study examines the association between collaborative capacity and supportive organizational context, supervisory support, and person-centered care in nursing homes to determine if similar relationships exist. Methods We adapted the Care Coordination Survey for nursing homes and administered it to clinical staff in 20 VA Community Living Centers. We used random effects models to examine the associations between supportive organizational context, supervisory support, and person-centered care with collaborative capacity outcomes including quality of staff interactions, task independence, and collaborative influence. Results A total of 723 Community Living Center clinical staff participated in the Care Coordination Survey resulting in a response rate of 29%. We found that teamwork and collaboration-measured as task interdependence, quality of interactions and collaborative influence-did not differ significantly between Community Living Centers but did differ significantly across occupational groups. Moreover, staff members' experiences of teamwork and collaboration were positively associated with supportive organizational context and person-centered care. Discussion Our findings suggest that elements of organizational context are important to facilitating collaborative capacity. Additionally, investing in staffing, rewards, and person-centered care may improve teamwork.
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Affiliation(s)
- Jennifer L Sullivan
- Center for Healthcare Organization and Implemenation Research, VA Boston Healthcare System, USA.,Boston University, USA
| | | | | | - Ryann L Engle
- Center for Healthcare Organization and Implemenation Research, VA Boston Healthcare System, USA
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Miller EA, Gidmark S, Gadbois E, Rudolph JL, Intrator O. Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration. Gerontologist 2018. [PMID: 28641378 DOI: 10.1093/geront/gnx096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA). Research Design and Methods Data derived from 35 semistructured interviews with discharge planning and contracting staff from 12 Veterans Affairs Medical Centers (VAMCs). Results VA staff placed a premium on Veteran and family preferences in the NH selection process, though VA staff knowledge and familiarity with placement options established the general parameters within which NH placement decisions were made. Geographic proximity to Veterans' homes and families was a major factor in NH choice. Other key considerations included Veterans' specialty care needs (psychiatric, postacute, ventilator) and Veteran/facility demographics (age, race/ethnicity, Veteran status). VA staff tried to remain neutral in NH selection, thus instructing families to visit facilities and review publicly available quality data. VA staff report that amenities (private rooms, activities, smoking) and aesthetics (cleanliness, smell, layout, décor) often outweighed objective quality indicators in Veteran and family decision making. Discussion and Implications Findings suggest that VAMCs facilitate Veteran and family decision making around NH selection. They also suggest that VAMCs endeavor to identify and recruit a broader array of higher quality NHs to better match the specific needs of Veterans and families to the choice set available.
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Affiliation(s)
- Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | | | - Emily Gadbois
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | - James L Rudolph
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
- Providence VA Medical Center, Rhode Island
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Orna Intrator
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
- Canandaigua VA Medical Center, New York
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, New York
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Miller EA, Intrator O, Gadbois E, Gidmark S, Rudolph JL. VA Staff Perceptions of Barriers and Facilitators to Home-and Community-Based Placement Post-Hospital Discharge. J Aging Soc Policy 2018; 31:1-29. [PMID: 29469672 DOI: 10.1080/08959420.2018.1444889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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.
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Affiliation(s)
- Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Orna Intrator
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA.,Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Emily Gadbois
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - James L Rudolph
- Providence VA Medical Center, Providence, Rhode Island, USA.,The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Miller EA, Gidmark S, Gadbois E, Rudolph JL, Intrator O. Nursing Home Referral Within the Veterans Health Administration: Practice Variation by Payment Source and Facility Type. Res Aging 2017; 40:687-711. [PMID: 28899261 DOI: 10.1177/0164027517730383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Edward Alan Miller
- 1 Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.,3 Providence VA Medical Center, Providence, RI, USA
| | | | | | - James L Rudolph
- 2 Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA.,3 Providence VA Medical Center, Providence, RI, USA.,4 The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Orna Intrator
- 2 Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA.,5 Canandaigua VA Medical Center, Canandaigua, NY, USA.,6 Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Miller E, Gadbois E, Gidmark S, Intrator O, Rudolph J. PERCEIVED BARRIERS AND FACILITATORS TO HOME AND COMMUNITY-BASED PLACEMENT IN THE VETERANS HEALTH ADMINISTRATION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E.A. Miller
- University of Massachusetts Boston, Boston, Massachusetts,
- Brown University, Providence, Rhode Island,
- Providence VA Medical Center, Providence, Rhode Island
| | - E. Gadbois
- Brown University, Providence, Rhode Island,
- Providence VA Medical Center, Providence, Rhode Island
| | - S. Gidmark
- Providence VA Medical Center, Providence, Rhode Island
| | - O. Intrator
- Canandaigua VA Medical Center, Canandaigua, New York,
- Brown University, Providence, Rhode Island,
- University of Rochester, Rochester, New York,
| | - J.L. Rudolph
- Brown University, Providence, Rhode Island,
- Providence VA Medical Center, Providence, Rhode Island
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Miller EA, Intrator O, Gadbois E, Gidmark S, Rudolph JL. VA staff perceptions of the role of the extended care referral process in home and community-based services versus nursing home use posthospital discharge. Home Health Care Serv Q 2017; 36:63-80. [PMID: 28605268 DOI: 10.1080/01621424.2017.1336960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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.
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Affiliation(s)
- Edward Alan Miller
- a Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies , University of Massachusetts Boston , Boston , Massachusetts , USA.,b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA
| | - Orna Intrator
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA.,c Geriatrics & Extended Care Data & Analysis Center, Canandaigua VA Medical Center , New York , USA.,d Department of Public Health Sciences, School of Medicine and Dentistry , University of Rochester , New York , USA
| | - Emily Gadbois
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA
| | - Stefanie Gidmark
- e Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center , Rhode Island , USA
| | - James L Rudolph
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA.,e Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center , Rhode Island , USA.,f The Warren Alpert Medical School , Brown University, Providence , Rhode Island , USA
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Dosa D, Cai S, Gidmark S, Thomas K, Intrator O. Potentially Inappropriate Medication Use in Veterans Residing in Community Living Centers: Have We Gotten Better? J Am Geriatr Soc 2013; 61:1994-9. [DOI: 10.1111/jgs.12516] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David Dosa
- Center of Innovation; Providence Veterans Affairs Medical Center; Providence Rhode Island
- Department of Medicine; Brown University; Providence Rhode Island
- Department of Health Services, Policy and Practice; Brown University; Providence Rhode Island
| | - Shubing Cai
- Center of Innovation; Providence Veterans Affairs Medical Center; Providence Rhode Island
- Department of Health Services, Policy and Practice; Brown University; Providence Rhode Island
| | - Stefanie Gidmark
- Center of Innovation; Providence Veterans Affairs Medical Center; Providence Rhode Island
| | - Kali Thomas
- Department of Health Services, Policy and Practice; Brown University; Providence Rhode Island
| | - Orna Intrator
- Center of Innovation; Providence Veterans Affairs Medical Center; Providence Rhode Island
- Department of Health Services, Policy and Practice; Brown University; Providence Rhode Island
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