Abstract
•Summarize unique characteristics of VA's Community Living Center.•Highlight the benefit of early inpatient hospice for veterans with complex needs. VA's health care offers a variety of services and benefits for the Veterans of the United States. Community Living Center (VA nursing home-CLC) is one of them. CLC’s aim is to restore Veterans to their highest level of well-being [Rehabilitation and Long Term Care (LTC/Rehab)] and provide comfort through inpatient hospice care (HC). To summarize the unique characteristics of VA’s Community Living Center serving both HC and LTC Veterans, comparing trends of special care and symptoms. Retrospective case-control study over 24-month period (Jan. 2014-Dec. 2015) data was analyzed, including San Antonio VA Veterans admitted to CLC HC as compared to LTC/Rehab. Results: N= 121, Mean age= 74years. 94% male. 52% Caucasian. 90 HC and 31 LTC/Rehab subjects. As expected, there was a significant decrease in Palliative Performance Score (PPS) in HC (67% HC with PPS <50% vs 26% LTC/Rehab; p<0.0001). Most HC subjects had a caregiver (64% vs 42%; p=0.028) and Do Not Resuscitate orders (90% vs 61%; p<0.0001). Admitting diagnosis of ESLD and HCC were more commonly seen among HC (24% vs 0%; p=0.04, and 12% vs 0%; p=0.04 respectively) while COPD and post-surgical rehab were more commonly seen in LTC/Rehab (0% HC vs 10%; p=0.0156 for each). 1% HC were referred from nursing facilities vs 16% LTC/Rehab (p<0.0001), and 22% HC referred from home hospice vs 0% (p<0.0001). HC spent less number of days in CLC as compared to LTC/Rehab [11.5 HC vs 68.0; p < 0.0001]. More HC subjects required wound care likely secondary to poor functional status (67% HC vs 40% CG; p=0.006). Pain was the most common complaint in both groups (81% HC vs 71%; p=NS) however, narcotics were prescribed more frequently in HC (90% vs 71%; p=0.01). 91% HG died while admitted vs 13% LTC/Rehab (p<0.0001) Inpatient hospice benefit is a unique care option available to terminally ill Veterans. These Veterans have complex care needs, multiple terminal diagnoses and uncontrolled symptoms. Other community options need to explore early inpatient hospice benefits for terminally ill patients as standard of care.
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