Providing All-Inclusive Care for Frail Elderly Veterans: Evaluation of Three Models of Care

Authors

  • Frances M. Weaver PhD,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • ab Elaine C. Hickey RN, MS,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • cd Susan L. Hughes DSW,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • ef Vicky Parker DBA,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • dg Dawn Fortunato MGS,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • h Julia Rose PhD,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • ij Steven Cohen MD,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • h Laurence Robbins MD,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • k Willie Orr MD,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • l Beverly Priefer PhD, APRN-BC,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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    • 1Formerly: AIC Project, Eastern Colorado Health Care System, Denver, Colorado.

  • m 1 Darryl Wieland PhD,

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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  • and n Judith Baskins RN, BSN op

    1. From the aCenter for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IllinoisbNorthwestern University, Chicago, IllinoiscCenter for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Hospital, Bedford, MassachusettsdBoston University, Boston, MassachusettseCenter for Research on Health and Aging, Chicago, IllinoisfSchool of Public Health, University of Illinois, Chicago, IllinoisgCenter for Organization, Leadership and Management Research, Veterans Affairs Boston Health Care System, Boston, MassachusettshVeterans Affairs Medical Center, Dayton, OhioiDivision of Geriatrics and Bioethics, Department of MedicinejAging and Cancer Program, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OhiokGeriatrics and Extended Care, Department of Veterans Affairs Eastern Colorado Health Care System, Denver, ColoradolMedical Services, Total Longterm Care, Denver, ColoradomWilliam S. Middleton Veterans Affairs Hospital, Madison, WisconsinnDivision of GeriatricsoSchool of Medicine, University of South Carolina, Columbia, South CarolinapPalmetto Health Geriatric Services, Columbia, South Carolina
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Address correspondence to Frances M. Weaver, PhD, Center for Management of Complex Chronic Care (151H), VA Hospital, Hines, IL 60141.
E-mail: frances.weaver@va.gov

Abstract

Frail elderly veterans aged 55 and older who met state nursing home admission criteria were enrolled in one of three models of all-inclusive long-term care (AIC) at three Veterans Affairs (VA) medical centers (n=386). The models included: VA as sole care provider, VA-community partnership with a Program of All-inclusive Care for the Elderly (PACE), and VA as care manager with care provided by PACE. Healthcare use was monitored for 6 months before and 6 to 36 months after enrollment using VA, DataPACE, and Medicare files. Hospital and outpatient care did not differ before and after AIC enrollment. Only 53% of VA sole-provider patients used adult day health care (ADHC), whereas all other patients used ADHC. Nursing home days increased, but permanent institutionalization was low. Thirty percent of participants died; of those still enrolled in AIC, 92% remained in the community. VA successfully implemented three variations of AIC and was able to keep frail elderly veterans in the community. Further research on providing variations of AIC in general is warranted.

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