Providing All‐Inclusive Care for Frail Elderly Veterans: Evaluation of Three Models of Care

Abstract

Frail elderly veterans aged 55 and older who met state nursing home admission criteria were enrolled in one of three models of all-inclusive long-term care (AIC) at three Veterans Affairs (VA) medical centers (n=386). The models included: VA as sole care provider, VA-community partnership with a Program of All-inclusive Care for the Elderly (PACE), and VA as care manager with care provided by PACE. Healthcare use was monitored for 6 months before and 6 to 36 months after enrollment using VA, DataPACE, and Medicare files. Hospital and outpatient care did not differ before and after AIC enrollment. Only 53% of VA sole-provider patients used adult day health care (ADHC), whereas all other patients used ADHC. Nursing home days increased, but permanent institutionalization was low. Thirty percent of participants died; of those still enrolled in AIC, 92% remained in the community. VA successfully implemented three variations of AIC and was able to keep frail elderly veterans in the community. Further research on providing variations of AIC in general is warranted.

Setting the Stage for a New Strategic Plan for Geriatrics and Extended Care in the Veterans Health Administration: Summary of the 2008 VA State of the Art Conference, “The Changing Faces of Geriatrics and Extended Care: Meeting the Needs of Veterans in the Next Decade”

“…Currently at 46 sites and serving approximately 15,000 Medicare enrollees aged 55 and older who would otherwise need nursing home care, PACE has demonstrated lower hospital and nursing home utilization and has low program disenrollment rates. Laurence Robbins spoke about the VA All-Inclusive Care project, a PACE adaptation in DenverFa partnership with Total Long Term Care (a PACE provider)Fthat was originally authorized as a pilot under the Mill Bill 12 and that has been sustained through post-pilot local support.…”

Frailty: a costly phenomenon in caring for elders with cognitive impairment

“…Evidence suggests that once an older patient has been identified as frail, the risk of adverse outcomes may be reduced via a comprehensive geriatric assessment with the development and implementation of a multidisciplinary treatment plan as well as possible exercise intervention (Walston and Fried, 2003;Ko, 2011). These approaches have been shown to improve functional status, reduce acute care hospital days and readmission and lower mortality rate for frail older patients in both outpatient and acute care settings (Landefeld et al, 1995;Eng et al, 1997;Weaver et al, 2008). If interventions such as these lessen the impact of frailty, they may also influence informal care costs.…”

Mortality After Lower Extremity Fractures in Men With Spinal Cord Injury

“…The covariates used in the adjusted models included age, race, level of injury, extent of injury, duration of injury, VA service‐connected status, health care utilization (outpatient and inpatient care), and comorbidities. Veterans with service‐connected status are those who have a medical or psychological condition or disability resulting from their military service and are eligible to receive additional benefits from the VA …”