ABSTRACT
The Elder Veteran Program (EVP) is a nursing-led approach to deliver inpatient consultative geriatrics care at our academic Midwestern Veterans Hospital. From April to December of 2021, EVP modified its workflow using a Plan-Do-Study-Act approach to include previously under-addressed components of the IHI's "4M's" of Age-Friendly Care (Medication, Mobility, Mentation, and What Matters), with three months of retrospective data review as a Plan phase, three months of monthly Do and Study phases, and a three month Act phase to analyze post-intervention care. We found improvements in frequency of documentation of Medication, Mentation, and What Matters in EVP notes, and maintenance of Mobility documentation. Next steps include translating these documentation and workflow changes into other relevant outcome measures and outreach to other departments. Overall, our project demonstrates a novel way to integrate these Pillars into a hospital system, by leveraging an existing nursing-led geriatric consult service focused on prevention and education.
Subject(s)
Geriatrics , Humans , Aged , Retrospective StudiesABSTRACT
Background: The US Department of Veterans Affairs (VA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides assistance for at-home caregiving of veterans and defers the costs of care for veterans. In October 2020, PCAFC eligibility expanded to include Vietnam-era veterans. Case Presentation: We present the case of a Vietnam-era veteran with posttraumatic stress disorder (PTSD) and Lewy body dementia (LBD) who over years of care developed worsening symptoms from his illnesses, including behaviors and psychological symptoms of dementia. Recurrent behavioral episodes and issues with home safety, along with his caregiver's financial need to continue working, led the patient to being placed in a VA-contracted skilled nursing facility. However, expanded PCAFC eligibility enabled a transfer back to in-home living. We discuss PCAFC expansion and examine trends in veteran health that point to a large burden of dementia and PTSD on both veterans and their caregivers. Conclusions: This case demonstrates how the PCAFC expansion is likely to benefit other older veterans with service-connected disability, PTSD, and/or dementia. These veterans may now be eligible for a service and funds that may enable at-home living. This expansion has policy implications as the VA manages the budget of this program and institutes measures to limit abuse and waste, as well as research implications as the PCAFC is used to enable at-home aging as an alternative to aging with dementia in a facility.
