Program and Policy Issues Affecting Home and Community-Based Long-Term Care Use: Findings from a Qualitative Study

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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Responses (N = 621) from a population-based statewide random digit dial telephone survey were analyzed to determine the sources of information respondents would use to locate home and community-based long-term care services and to identify predictors of use of each source. Respondents turn to formal sources of information more than informal sources, and age, race, income, and gender significantly predicted the source of information used. Findings support development of targeted public awareness campaigns that take a multi-pronged approach using multiple dissemination mechanisms to inform the public about long-term care options.