In fiscal year 2020, the Department of Veterans Affairs (VA) is projected to spend $9.8 billion on long-term care services for eligible Veterans. Recent legislation have created and expanded VA programs to support informal caregivers (ie, family or friends who provide unpaid care for Veterans with substantial impairments). A substantial proportion of Veterans with impairments served after September 11, 2001; there is a higher prevalence of mental health conditions for this younger group, and their caregivers are more likely to lack social support networks.

In 2017, the VA Secretary launched the Choose Home Initiative to enhance VA policies and practices for supporting Veterans and their informal caregivers, and to improve collaboration with non-VA community groups. To help VA policymakers understand the effects of VA-provided or -funded home and community-based services (HCBS), particularly with regard to avoiding long-term nursing home placement (NHP), the VA Evidence Synthesis Program (VA ESP) was asked to examine evidence on modifiable risk factors for long-term NHP and interventions that aimed to delay long-term NHP for community-dwelling adults with physical and/or cognitive impairments.

We sought evidence for both adults with existing disabilities (or at high risk for developing impairments) and individuals with posttraumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). To address the broad scope of questions for these diverse populations and to provide specific recommendations for VA policies, we undertook an umbrella review of systematic reviews. We present qualitative summaries of results from the highest quality and most recent reviews covering the largest range of risk factors and interventions. We also describe policy implications and evidence gaps.

Contents

• Preface
• Acknowledgments
• Executive Summary
  • Introduction
  • Methods
  • Results
  • Discussion
  • Abbreviations Table
• Introduction
• Methods
  • Topic Development
  • Search Strategy
  • Study Selection
  • Data Abstraction & Quality Assessment
  • Data Synthesis
  • Peer Review
• Results
  • Overview
• Discussion
  • Summary of Key Findings
  • Implications for Policy
  • Evidence Gaps & Future Research Needs
  • Limitations
  • Conclusion
• References
• Appendices
  • APPENDIX 1. Search Strategies
  • APPENDIX 2. Study Selection Criteria
  • APPENDIX 3. Quality Assessment
  • APPENDIX 4. Peer Review Comments/Author Responses
  • APPENDIX 5. Evidence Tables

Suggested citation:

Duan-Porter W, Ullman K, Rosebush C, McKenzie L, Ensrud KE, Ratner E, Greer N, Shippee T, Gaugler J, and Wilt TJ. Risk Factors and Interventions to Prevent or Delay Long-Term Nursing Home Placement for Adults with Impairments. VA ESP Project #09-009; 2019. Available at: https://www.hsrd.research.va.gov/publications/esp/reports.cfm.

This report is based on research conducted by the Evidence Synthesis Program (ESP) Center located at the Minneapolis VA Health Care System, Minneapolis, MN, funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.