Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.
Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA.
J Aging Soc Policy. 2019 Jan-Feb;31(1):1-29. doi: 10.1080/08959420.2018.1444889. Epub 2018 Apr 10.
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.
本研究确定了美国退伍军人事务部（VA）工作人员认为有助于或阻碍退伍军人在出院后接受家庭和社区为基础的服务（HCBS）的因素。数据来自全国 12 个 VA 医疗中心的 35 名工作人员的半结构化访谈。VA 工作人员报告说，退伍军人的护理需求、社会和财务资源影响 HCBS 的安置。他们还报告了成功安置的前提条件，包括住房、无报酬的非正式护理，以及由私人和公共项目（如医疗补助和《美国老年人法》）资助的非 VA 服务。人员配备不足和未能提供所需的特定类型的服务限制了对 HCBS 的转介和使用。预算要求影响了 VA 医疗中心之间 HCBS 的相对可用性。研究结果突出了患者、提供者和系统层面的限制因素，这些因素阻碍了需要长期服务和支持的退伍军人在出院后能够成功地在家中和社区中安置。
