Keywords: long-term care, nursing home, hospitalization, Veterans
In the Veterans Health Administration, hospitalizations from the nursing home can cause distress and disruption of continuity of care for patients and impose costs on the health system. The VA issued directives in 2008 and 2012 to shift the use of its VA-owned and –operated Community Living Centers (CLCs) away from long-stay care and toward short-stay and post-acute care. In this study, we described trends in hospitalization rates among long- and short-stay Veterans. We studied 133 CLCs from 2007 to 2015. Because post-acute-care patients tend to be at higher risk of hospitalization, we identified continuous episodes of care in the CLC and stratified the analysis by short-stay (=90 days) and long-stay episodes. We compare the trend in hospitalization rates to community-based nursing homes in nearby markets, adjusting for case-mix acuity and proportion of long-stay patients. Overall, hospitalizations in CLCs decreased from 1.31 per resident-year in 2007 to 1.17 in 2015. In spite of high staff-to-resident ratios compared to community nursing homes, this rate is higher than among similar facilities in the community.