VA Staff Perceptions of Barriers and Facilitators to Home-and Community-Based Placement Post–Hospital Discharge |
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| Authors: | Edward Alan Miller Orna Intrator Emily Gadbois Stefanie Gidmark James L Rudolph |
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| Institution: | 1. Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts, USA;2. Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA;3. Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA;4. Canandaigua VA Medical Center, Canandaigua, New York, USA;5. Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA;6. Providence VA Medical Center, Providence, Rhode Island, USA;7. The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA |
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| 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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| Keywords: | Veterans Affairs home- and community-based services nursing homes long-term care qualitative interviews hospital discharge planning |
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