Senior Coordinated Referral Study
Senior Coordinated Referral Study
Long-term care (LTC) can be defined as the range of institutional and home and
 community-based services that support individuals needing chronic care. The defining values
 of LTC in the VA include caring for patients in the "least restrictive environment consistent
 with meeting a patient's needs". VA faces an increasing demand for these services with the
 growing number of veterans 85 years and older, those most in need of LTC. Yet in fiscal year
 2007, 87% of the 3.5 billion total VA dollars spent on LTC went to institutional care rather
 than the less restrictive Home and Community Based Services (HCBS). VA Central Office has
 formally committed to tripling the proportion of LTC that is HCBS between 1999 and 2011.

 Study Objectives: (1) Develop and test measures of patient/caregiver and provider
 satisfaction. (2) Develop and test measures of process and cost of the LTC referrals.

 Methods: Three VAMCs in VISN 11 are the study setting. This study was conducted from October
 2007-June 2010 and utilized a variety of data sources throughout this timeframe. Data sources
 included: the Geriatric Extended Care form, telephone and in-person interviews, online and
 paper surveys, Extended Care Screening Committee meeting minutes, and technical reports from
 the Health Economics Resource Center.

 Status: Complete.
Long-term care (LTC) can be defined as the range of institutional and home and
 community-based services that support individuals needing chronic care. The defining values
 of LTC in the VA include caring for patients in the "least restrictive environment consistent
 with meeting a patient's needs". VA faces an increasing demand for these services with the
 number of veterans 85 years and older, those most in need of LTC. Yet in fiscal year 2007,
 87% of the 3.5 billion total VA dollars spent on LTC went to institutional care rather than
 the less restrictive HCBS. VA Central Office has formally committed to tripling the
 proportion of LTC that is HCBS between 1999 and 2011.

 Findings from our team's study, Assessing Practice Variation in LTC Referrals (IIR 02-228,
 2006), evaluated the LTC referral process from the perspective of the referring staff,
 administrators, and veterans and their families. We found that the referral process is
 frequently unstandardized, inefficient, and not supportive of referrals to home and
 community-based services. VAMCs across the country have varying ways of providing LTC
 referrals and some look promising. Measures of the outcomes for evaluating these systems are
 available with the exception of two important outcomes, satisfaction with the referral and
 its process and cost. The goal of this study is to develop the cost and process and
 satisfaction measures so that such an evaluation can be conducted.

 Study Objectives: (1) Develop and test measures of patient/caregiver and provider
 satisfaction. (2) Develop and test measures of process and cost of the referrals. The long
 term objective of our research is to identify and implement models of LTC referral with the
 best outcomes.

 Methods: Three VAMCs in VISN 11 with 3 different methods of LTC referral are the study
 setting. This study was conducted from October 2007-June 2010 and utilized a variety of data
 sources throughout this timeframe. Data sources include: the Geriatric Extended Care (GEC)
 form, telephone and in-person interviews, online and paper surveys, Extended Care Screening
 Committee meeting minutes, and technical reports from the Health Economics Resource Center
 (HERC). The GEC forms provided recruitment information for Veterans, caregivers, social
 workers and nurses in both the cost and satisfaction portions of the study and were randomly
 pulled by the Clinical Application Coordinators at each site. Recruitment information for VA
 and non-VA long term care (LTC) coordinators was supplied by Site Investigators. The cost
 portion of the study also utilized the Extended Care Screening Committee meeting minutes and
 salary information for VHA employees from the HERC technical report.

 Site Investigators facilitated completion of the paper surveys by attending department
 meetings, and coordinated in-person interviews with providers interested in participating in
 the study. For all telephone interviews, participants received an introduction to the study
 through the mail or email. Veterans and caregivers were mailed information while VA social
 workers, nurses, physicians and LTC coordinators were contacted via email. Potential
 participants then received a telephone call from a Research Assistant who further explained
 the study and inquired about his/her interest in participation. For the satisfaction online
 survey, providers were able to complete the survey after receiving the email introduction.

 Status: Complete.
Inclusion Criteria:

 Veteran with completed Geriatrics and Extended Care Referral Form in data base at study
 site

 Exclusion Criteria:

 Inability to complete telephone interview