Outsourcing Veterans for Long Term Care: Comparison of Community and State Veterans' Nursing Homes
Laberge, Alexandre, Weech-Maldonado, Robert, Johnson, Christopher E., Jia, Huanguang, Dewald, Lloyd, Journal of Health and Human Services Administration
This study compares the characteristics of state veterans' nursing homes and community nursing homes with VA per-diem residentes between 1999-2002. A structure, process, and outcome model was used to examine whether there was any difference in the multi-dimensional quality measures among the three types of community nursing homes (for profit, not-for-profit, and government) and state veterans' nursing homes. For profit community nursing homes were less likely to achieve nurse staffing standards while government facilities were more likely to achieve CNA staffing standards when compared to the state veterans' homes. All community nursing homes had a lower prevelance of tube feeds and catheterization when compared to state veterans' nursing homes. Only government community nursing homes had significantly lower quality of life deficiencies and pressure sore prevelance when compared to state veterans' nursing homes. Vigilant monitoring of all long-term care facilities utilized by veterans is needed.
Veterans with institutional long-term care needs have historically resided in Veterans Administration (VA) nursing homes, community nursing homes, or state veterans' nursing homes. From 1998 to 2005, utilization of state veterans' nursing homes increased from 14,600 to almost 18,000 residents (GAO 2004, 2006). In 2005, the VA also outsourced over 4,400 veterans to community nursing homes (GAO 2006). In 2005, community nursing homes and state veterans' nursing homes provided care for over 60% of all veterans residing in long-term care facilities (GAO 2006).
The VA faces a daunting task of providing institutional long-term care to a rapidly increasing aging veteran population. The number of veterans over the age of 85 is expected to increase by 145% (from 278,400 to 681,400) between the years 2004 and 2012 (US Senate Committee, 2005). People aged 85 years and older are the heaviest users of long-term care with nearly one in five of them living in nursing homes in 2000 (U.S. Bureau of the Census, 2001). The VA is responding to this need by outsourcing veterans to both community nursing homes and state veterans' nursing homes. Therefore, it is of utmost importance for the VA to examine the quality of care that veterans receive in these types of facilities.
There are very few empirical research studies that have evaluated the quality of care provided to veterans in either type of nursing home. Berlowitz et al. (2005) compared the quality of care for veterans in VA nursing homes and those on contract in community nursing homes. Using data for the state of New York from 1997 to 1999, this study found that veterans in VA nursing homes were significantly less likely to develop a pressure ulcer but more likely to experience functional decline than veterans in community nursing homes. On the other hand, residents of community nursing homes with VA contracts were significantly less likely to develop a pressure ulcer but more likely to die than residents in non-contract homes. Few nursing homes were consistently among the best or worst performers on three risk-adjusted quality measures: pressure ulcers, functional decline and mortality. Only 19 of 650 nursing homes, of which four had VA contracts, were in the top quartile on all three performance measures. Fifteen nursing homes, seven of which had VA contracts, were in the bottom quartile on all performance measures. Johnson et al. (2006) compared the quality of care between community nursing homes with veterans and community nursing homes without veterans. Nursing homes participating in the VA Community Nursing Home Program were less likely to meet CNA or RN standards, had more residents being tube fed, newly catheterized, and restrained. These facilities also had higher levels of deficiencies across all of the types examined (quality of care, quality of life, total deficiencies, and actual harm citations) and the residents were more likely to have new pressure sores. …