Miller Edward Alan, Gidmark Stefanie, Gadbois Emily, Rudolph James L, Intrator Orna
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.
Res Aging. 2018 Aug;40(7):687-711. doi: 10.1177/0164027517730383. Epub 2017 Sep 13.
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.
在美国退伍军人事务部（VA）的退伍军人健康管理局（VHA）登记的退伍军人可在VHA运营的社区生活中心（CLC）、州退伍军人之家（SVH）或社区疗养院接受疗养院护理，这些机构可能与VHA签有合同，也可能没有。本研究调查了VHA工作人员对退伍军人获得VA及其他支付方式资格如何影响VA医疗中心（VAMC）内疗养院转诊的看法。对来自全国12个VAMC的出院计划和合同工作人员进行了35次半结构化访谈。VA工作人员强调了VA优先地位在确定VA支付的疗养院护理安置方面所起的突出作用。VHA工作人员报告称，退伍军人安置在CLC、社区疗养院或SVH，部分取决于潜在支付来源（VA、医疗保险、医疗补助和其他）以及预期住院时间。他们还报告称，不同VAMC之间退伍军人转诊至VA支付的疗养院护理存在差异，部分原因在于当地和地区政策及市场的不同。得出了VHA内疗养院转诊的相关结论。
