Purchasing High-Quality Community Nursing Home Care: A Will to Work With VHA Diminished by Contracting Burdens

Kate H Magid; Emily Galenbeck; Leah M Haverhals; Portia Y Cornell; Patience Moyo; Amy L Mochel; Emily Corneau; James L Rudolph; Vincent Mor; Cari Levy

doi:10.1016/j.jamda.2022.03.007

Purchasing High-Quality Community Nursing Home Care: A Will to Work With VHA Diminished by Contracting Burdens

J Am Med Dir Assoc. 2022 Nov;23(11):1757-1764. doi: 10.1016/j.jamda.2022.03.007. Epub 2022 Apr 14.

Authors

Affiliations

¹ Rocky Mountain VHA Medical Center, Aurora, CO, USA. Electronic address: Kate.Magid@va.gov.
² Rocky Mountain VHA Medical Center, Aurora, CO, USA.
³ Rocky Mountain VHA Medical Center, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
⁴ Providence VHA Medical Center, Long Term Services and Supports Center of Innovation, Providence, RI, USA; Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA.
⁵ Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA.
⁶ Providence VHA Medical Center, Long Term Services and Supports Center of Innovation, Providence, RI, USA.

Abstract

Objectives: The Veterans Health Administration (VHA) purchases community nursing home care; however, the administrative burden may lead nursing homes to avoid contracting with the VHA. This study aimed to describe how the VHA's purchasing policies impede or facilitate contracting with nursing homes.

Design: Semistructured interviews of key stakeholders in the VHA's community nursing home contracting process.

Setting and participants: We interviewed 15 VHA and 21 nursing home staff at 6 VHA medical centers and 17 nursing homes. VHA medical centers were selected from sites with the greatest magnitude of difference in quality rankings between VHA contracted and noncontracted nursing homes in the same market area.

Methods: Qualitative content analysis of interviews.

Results: Five themes emerged: (1) VHA purchases nursing home care to fill gaps in geographic, specialty, and quality care needs; (2) business opportunities and the mission to care for Veterans motivate nursing homes to work with the VHA; (3) the VHA's reputation for unreliable or insufficient payment and inability of nursing homes to comply with federal wage standards serve as barriers to establishing contracts; (4) complexity of establishing a contract, ambiguity about new policies, and inadequate VHA staffing for the nursing home inspection team hinder the VHA's ability to establish contracts with nursing homes; and (5) nursing homes that have established corporate processes, nursing home administrators with prior experience working with the VHA, and relationships between VHA and nursing home staff serve as facilitators to establishing new nursing home contracts.

Conclusions and implications: Nursing homes will work with the VHA, but the process of executing VHA contracts is burdensome. Streamlining and standardizing the purchasing processes and ensuring timely payment may expand the number of nursing homes willing to contract with the VHA, thereby increasing choices for Veterans and becoming a model for other long-term care networks.

Keywords: VHA-purchased care; Veterans Affairs; community care; nursing home.

Published by Elsevier Inc.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Consumer Behavior
Humans
Long-Term Care
Nursing Homes
United States
United States Department of Veterans Affairs*
Veterans*

Grants and funding

I01 HX002529/HX/HSRD VA/United States