Journal Article

Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration

Edward Alan Miller, Stefanie Gidmark, Emily Gadbois, James L Rudolph and Orna Intrator

in The Gerontologist

Published on behalf of The Gerontological Society of America

Volume 58, issue 4, pages e226-e238
Published in print July 2018 | ISSN: 0016-9013
Published online June 2017 | e-ISSN: 1758-5341 | DOI: https://dx.doi.org/10.1093/geront/gnx096
Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration

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Abstract

Background and Objectives

Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA).

Research Design and Methods

Data derived from 35 semistructured interviews with discharge planning and contracting staff from 12 Veterans Affairs Medical Centers (VAMCs).

Results

VA staff placed a premium on Veteran and family preferences in the NH selection process, though VA staff knowledge and familiarity with placement options established the general parameters within which NH placement decisions were made. Geographic proximity to Veterans’ homes and families was a major factor in NH choice. Other key considerations included Veterans’ specialty care needs (psychiatric, postacute, ventilator) and Veteran/facility demographics (age, race/ethnicity, Veteran status). VA staff tried to remain neutral in NH selection, thus instructing families to visit facilities and review publicly available quality data. VA staff report that amenities (private rooms, activities, smoking) and aesthetics (cleanliness, smell, layout, décor) often outweighed objective quality indicators in Veteran and family decision making.

Discussion and Implications

Findings suggest that VAMCs facilitate Veteran and family decision making around NH selection. They also suggest that VAMCs endeavor to identify and recruit a broader array of higher quality NHs to better match the specific needs of Veterans and families to the choice set available.

Keywords: Decision making; Discharge planning; Interviews; Nursing home choice; Nursing Home Compare; Qualitative; Veterans Health Administration

Journal Article.  9489 words. 

Subjects: Geriatric Medicine ; Biological Sciences ; Psychology ; Care of the Elderly ; Gerontology and Ageing

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