Puzzling Pieces Validating the VA Long Term Care 4.27.09

PUZZLING PIECES: VALIDATING THE VA LONG TERM CARE (LTC) HOME AND COMMUNITY BASED CARE (HCBC) PROJECTIONS Bruce Kinosian(1,2); Eric Stallard (3); A. Canamucio 1 , D. Polsky 1, 2 , K. Manton (3), T Edes (4), Dan Schoeps (4) (1) CHERP, Philadelphia VA Medical Center, Philadelphia, PA, (2) Division of General Internal Medicine, University of Pennsylvania, PA (3) Dept. of Sociology, Duke University, Durham, NC (4) Geriatric and Extended Care, VA Central Office, Washington, DC Conclusions and Policy Implications ADC by HCBC type FY2004 , Actual Total and Survey Sample ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Background Evaluate 2003 LTC Planning Model projections for HCBC use Objective ABSTRACT BODY: Objective: Evaluation of LTC projections for HCBC using available CMS and VA administrative data. Methods: We developed a static projection model, using the 2002 enrolled veteran population stratified by age/gender/priority/VISN. We imputed disability and marital status from the 1999 National Long Term Care Survey (NLTCS) for those age 65+, and the National Health Interview Survey for those < 65. We constructed HCBC use rates for each age/gender/marital status/priority/disability level from the 1999 NLTCS for those aged 65+ and from the 2000 National Home Care and Hospice Survey (NHHS) for those age < 65. For validation, we matched the 2004 NLTCS with the VA enrollment file, and summarized VA HCBC use among matched survey respondents. We matched the 2004 OASIS file with the 2004 enrollment file, to obtain skilled home health episodes, and imputed Average Daily Census (ADC) based on length of episode and visits. HCBC services were operationalized as Medical (Home Based Primary Care (HBPC),Skilled home health, Hospice) and Supportive(other home health, ADHC, In-home Respite). Additional supportive HCBC from the NLTCS included Assisted Living and formal help. ADC was calculated by using current VA workload recording procedures. Results: Validation data were reliably available for age 65+, representing 118,300/162,000 ADC (73%). Actual VA supplied HCBC ADC was 17,471,(14% of total) and 16,871 estimated from the NLTCS cohort. Total utilization, using the NLTCS cohort was 121,435 (Medical HCBC ADC 50,905/Supportive HCBC ADC 70,530), and 125,188 using VA/OASIS utilization for Medical HCBC. For HBPC, VA supplied 59.8% of total ADC using the NLTCS cohort (12,041/20,112), indicating frail, enrolled veterans receive a large amount of in-home primary care from non-VA providers. Hospice accounted for nearly 1/4 of Medical HCBC (12,800). Non-Federal sources paid for 46% of formal ADC, while only 26% of ADC for those with 3+ ADL dependencies were provided by formal (paid) help. In 2007, actual VA supplied Medical HCBC was 42% of model projections. Conclusions: Enrolled veterans receive a large amount of HCBC services, most is informal, with projections closely matching actual ADC, of which VA provided 31% of Medical but 19% of total HCBC, and 59% of in-home primary care in 2004. Financial Disclosure : VA HSR&D; VA ADUSH Office of Policy and Planning Abstract Projection for LTC 3.1 (1999 rates) and LTC 4.1 (2004 rates ) All Ages ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Results ,[object Object],[object Object],[object Object],Service FY 2004 ADC NLTCS FY2004 VA NLTCS non-VA OASIS 2004 2004 NLTCS (combined) 2004 NLTCS (combined) (OASIS HH+VA FY2004+NLTCS non-VA) Skilled Home Health 2,606 ,1391 11,134 12,525 Other Home Health 3,268 1,518 ,6474 7,992 Total Medicare Home Health 5,874 2,904 17,608 17,544 20,517 20,812 HBPC 9,824 12,041 8,071 20112 17,895 Home Hospice 164 0 12,819 12,819 12,983 Adult Day Health Care 1525 1,774 0 1,774 1525 Respite 84 93 0 93 84 Total no Assisted Living 17,471 16,818 38,498 55,315 53,299 Community Assisted Living/community residential care 5,771 0 11,435 11,435 17,206 Sub-total 23,242 16,818 49,933 66,750 70,505 Non-Medicare, Non-Asst. Living, Formal Help 54,683 54,683 54,683 Sub-total 104,616 121,435 125,188 Medical HCBC 13,432 37,473 50,905 Supportive HCBC 3,386 67,144 70,530 121,435 2005 LTC 3.1 168,292 LTC 3.1 Using Current Population 214,353 ADL Dependency: 3.1 :408,636 4.1: 632,689 4.1 HCBC projection 134,989 Medical 57,229 Support 77,760

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Puzzling Pieces Validating the VA Long Term Care 4.27.09