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Care Transitions to the Community from Veterans Affairs Nursing Homes: Experiences of Social Connection and Disconnection.
Simons, Kelsey V; Bower, Emily S; Gillespie, Suzanne M; Mills, Whitney L.
  • Simons KV; VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address: Kelsey.Simons@va.gov.
  • Bower ES; VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY.
  • Gillespie SM; Canandaigua VA Medical Center, Canandaigua, NY; Division of Geriatrics/Aging, Department of Medicine, University of Rochester School of Medicine, Rochester, NY.
  • Mills WL; Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI; Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI.
J Am Med Dir Assoc ; 22(3): 682-688, 2021 03.
Article in English | MEDLINE | ID: covidwho-761756
ABSTRACT

OBJECTIVE:

This study aimed to further knowledge of older Veterans' experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning.

DESIGN:

A qualitative study design was used in addition to administration of standardized depression and mental status screens. SETTING AND

PARTICIPANTS:

Veterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York.

METHODS:

Semistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2-4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge.

RESULTS:

Thematic analysis of verbatim transcriptions revealed 3 inter-related themes (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans' expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as "lonely" after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status range = 14-15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire mean = 4.9, SD = 6.1, median/mode = 3, range = 0-23). CONCLUSIONS AND IMPLICATIONS This study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans Type of study: Qualitative research Topics: Long Covid Limits: Humans / Male Country/Region as subject: North America Language: English Journal: J Am Med Dir Assoc Journal subject: History of Medicine / Medicine Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans Type of study: Qualitative research Topics: Long Covid Limits: Humans / Male Country/Region as subject: North America Language: English Journal: J Am Med Dir Assoc Journal subject: History of Medicine / Medicine Year: 2021 Document Type: Article