(P42) Long-Term-Care Referral Process for Veterans with a Mental Health Diagnosis

Objective/Aim: This study aimed to improve the referral process for Veterans with mental health who are seeking long-term care with their local Veterans Affairs Medical Facility (VAMC) through a needs and gaps analysis of a VAMC in New England. Hackman and Oldham’s (1976) framework was applied which highlights the need for stakeholders to know the whole process. Providers serving aging Veterans with a mental health diagnosis need a standardized referral process that can support Veterans in their application to long-term care. The compartmentalization of workflow is negatively impacting care and preventing disciplines who are stakeholders to have ownership in the entire referral process.

Background: Nursing Home Care relies on a referral process from the Veterans Affairs (VA) medical facility when serving enrolled Veterans. Providers at this New England facility only know their step in this process and are working in silos with a lack of understanding of how their role contributes to the greater process. Required documentation for the referral process is being improperly completed resulting in long wait times and inappropriate placements. The Pre-Admission Screening Resident Review (PASRR) has become the standard screening tool for identifying individuals with a mental health diagnosis (Post et al., 2010). The goal is to screen for appropriate level of care and to protect an at-risk population (Post et al., 2010). Limited funding to implement this tool impacted individual states’ ability to provide training which led to varied results across the country (O’Connor, 2018). Further research is needed to explore if there is a possible impact on a local facility level.

Quality Improvement

Methods: Survey, 9 interviews, Mental Health Admission Data Collection

Results: More than 45% of all clinical staff at the medical facility reported not feeling confident or only slightly confident on their knowledge of the Long-Term Care Referral Process while 71% reported not feeling confident or slightly confident on their knowledge of the PASRR as part of the referral process. Data Collection from Geriatric programs found all four programs had 35% or more Veterans enrolled with a Mental Health diagnosis. A central theme from the stakeholder interviews was that staff only knew their piece and that this impacted the quality of patient care and efficiency in placement.

Conclusions: A lack of knowledge of the whole referral process is negatively impacting nursing home placements with an inconsistency in completing the PASRR which supports existing literature on a need for a standardization of the PASRR and an Interdisciplinary approach. This study introduced an approach to standardize the PASRR implementation and improve the effectiveness of the LTC referral process through Oldham & Hackman’s theoretical framework. Results from this study suggest a need for comprehensive education and for future training to include all stakeholders of the process together in order to produce the most efficient and effective outcome.

References:
Hackman, J. & Oldham, G. (1976) Motivation through the design of work: test of a theory. Organizational Behavior and Human Performance. 16 (2) 250-279.
O’Connor, 2018) Leveraging the PASRR Process to Divert and Transition Elders with Mental Illness from Nursing Facilities. Journal of Aging & Social Policy. 23. pp.305-322.
Post, E., Metzger, M., Dumas, P., Lehmann, L. (2010) Integrating Mental Health into Primary Care within the Veterans Health Administration. Families, Systems & Health. 28 (2) 83- 90.