Long Term Care Data for Veterans

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Overview

VA provides an extensive array of long-term care (LTC) to veterans. VA provides institutional long term care to veterans through VA Nursing Homes, Community Nursing Homes, State Veteran Homes, and Domiciliaries. VA also provides assistance to some veterans through the Community Residential Care program. Other services offered in both inpatient and outpatient settings include Hospice, Respite Care, and Geriatric Evaluation and Management (GEM). Other outpatient LTC services provided by VA include Home Based Primary Care, Community Home Health Care, Adult Day Health Care, and Homemaker/ Home Health Aide Services.

Eligible veterans can also receive some LTC services through Medicare. Medicare provides Community Home Health Care, Community Nursing Home, and Hospice services.

Because of the wide variety of venues for the delivery of LTC services, there is no single database for all LTC services provided to veterans. Instead, data are located in various databases. Table 1 summarizes the types of long-term care services available to veterans, as well as where data can be found. Table 2 contains a summary of the databases that contain LTC data, how to access the database, and which LTC services it includes.

It is important to note that in some cases, data integrity may be in question. For example, not all veterans in a State Veterans Home are found in the Fee Basis files, nor are all those in Community Nursing Homes found in the Medical SAS Inpatient: Extended file. Although all HBPC visits should be recorded in both the Medical SAS Outpatient and HBPC visit files, about 10% are found in only the Medical SAS Outpatient file or the HBPC visit file. Hospice and respite care are identified through ICD-9 codes, but often the code is not listed in the patient's record. VIReC is working to provide researchers with information about the accuracy of LTC data in these databases.

Table 1: Long Term Care Services

Table 2: Long Term Care Datasets

Documentation

VA Long Term Care: Programs and Services is a three-volume guide published in August 1996

Now retained as VIReC historical documents

• Introduction
• Volume I an overall description of the services and programs, existing databases and how they may be accessed, issues of data quality and areas in which the databases are incomplete, and a description of paper records and local VAMC efforts to compile information on a particular program or service.
• Volume II a compendium of database file names, content statements, and value labels (when available) for all databases identified in Volume I, and a table comparing the variables available in each database.
• Volume III a listing of relevant Health Services Research projects on VA LTC services, including abstracts and bibliographies when available.
• An Overview Of VA Long-Term Care Database And Information Resources was published in September 2000 in VIReC Insights as an update to the guide listed above.

VIReC is currently working to provide a current Research User Guide to Long Term Care Data for Veterans.

LTC resources in the VA

• Geriatric Research Education and Clinical Centers (GRECCs)
• Geriatrics & Extended Care Strategic Healthcare Group

Overviews of VA LTC

• VA Covered Services: Long-Term Care
• HSR&D Health Spotlight: Long-term care (LTC) (2003)
• HSR&D Management Brief: Long-Term Care Needs Increase as Veteran Population Ages (October 2000)

VHA Publications

VHA Directives

2008-007	Resident Assessment Instrument Minimum Data Set (RAI/MDS)	2-4-08
2006-014	Admission Criteria, Service Codes, and Discharge Criteria for VA Nursing Home Care Units (NHCU)	3-24-06
2005-061	VA Nursing Home Care Unit (NHCU) Admission Criteria, Service Codes, and Discharge Criteria	12-7-05
2005-060	Implementation of the Medicare Prospective Payment System (PPS) Assessment Form (MPAF)	12-7-05
2005-008	Documentation of Kinesiotherapy Services in Department Of Veterans Affairs (VA) Nursing Home Care Units	3-3-05
2004-059	Geriatrics and Extended Care (GEC) Referral	10-21-04
2004-025	Extended Care Fund (36X4032)	6-10-04
2004-026	Income Thresholds Used in Identifying Veterans Exempt from Extended Care Service and Outpatient Medication Co-Payment and in Determining Eligibility for Beneficiary Travel	6-10-04
2004-019	Eligibility for Nursing Home Care	5-17-04
2003-008	Palliative Care Consult Teams (PCCT)	2-4-03
2002-065	Implementation of Co-Payments for Extended Care Services Provided to Veterans by VA	10-21-02
2002-054	Intermediate Care Long-Term Care Treating Specialty	9-18-02
2002-038	Hospice and Palliative Care Workload Capture	7-5-02
2002-016	Respite Care	3-19-02

VHA Handbooks
Back to VHA Publications

1140.1	Community Residential Care Program	3-29-07
1140.2	Respite Care	5-15-03
1140.3	Home Health and Hospice Care Reimbursement Handbook	8-16-04
1140.4	Geriatric Evaluation and Management Procedures	2-2-05
1140.5	Community Hospice Care: Referral and Purchase Procedures	3-1-05
1140.6	Purchased Home Health Care Services Procedures	7-21-06
1141.01	Home-based Primary Care Program	1-31-07
1143.2	VHA Community Nursing Home Oversight Procedures	6-4-04

VHA Manuals Back to VHA Publications

VHA Letters Back to VHA Publications

11-2005-001	Implementation of the RAI/MDS on LTC-SCI Units	1-6-05
10-2004-005	Non-Institutional Extended Care	5-3-04
10-2007-007	Veterans On Whose Behalf VA Pays Per Diem to States for Care in State Veterans Homes	3-8-07

Data Briefs from Health Care Financing & Economics (HCFE)
Back to VHA Publications

2005-02	Forecasting trends in VA long-term care in the absence of the Millennium Act through fiscal year 2002	7-20-05
2005-01	Unintended effects of Millennium Act on veterans' service-connected status	6-16-05
2004-08	Intensity of follow-up care to inpatient detoxification: The relative impact of domiciliary care in the Veterans Health Administration	3-04
2004-06	Hospice and palliative care for VA patients	11-19-04
2004-05	VA Long-Term Care Patients’ Medicare and Medicaid Expenditures	11-19-05
2004-04	The Effect of the Balanced Budget Act on Veterans' Use of Home Health Services	9-10-04
2004-03	Validating MDS Data from VA Nursing Home Care Units: Comparing VA and Community Quality Measures	10-13-04
2004-02	Validating MDS Data from VA Nursing Home Care Units: Comparing MDS Data with PAF and NPCD Sources	10-13-04
2004-01	Validating MDS Data from VA Nursing Home Care Units: Data Appears to be Internally Consistent and Reliable	10-13-04

Help

For additional support, please contact the VIReC Help Desk or call VIReC at 708-202-2413.