Care Transitions to the Community From Veterans Affairs Nursing Homes: Experiences of Social Connection and Disconnection
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. A qualitative study design was used in addition to administration of standardized depression and mental status screens. Veterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York. 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. 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). 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.
Abstract: One of the key achievements of Forces in Mind Trust’s (FiMT) Our Community - Our Covenant series of reports, beginning in 2016, has been to establish a toolkit for local authorities to help them develop support for their local Armed Forces Community (AFC). The 2016 report launched the idea of a “core infrastructure”, supported by self-assessment questions and some wider tips. Formal research and informal engagement show that the toolkit still provides an important contribution to successful local delivery of Covenant pledges and wider AFC support. It’s a baseline in the face of ever-present funding stresses and a point of reference when there are changes in member and officer responsibilities. This means it is important that the toolkit remains up to date. It was last reviewed in 2022 and presented as an Annex to FiMT’s research report A Decade of the Covenant. Since then, there has been further research into local support for the Armed Forces Community for the next iteration of the Our Community - Our Covenant series. This updated toolkit reflects these recent findings about local practice as well as developments following the introduction in the Armed Forces Act 2021 of the duty of due regard to the principles of the Covenant in the focus areas of housing, education and healthcare. As with the original document, the toolkit remains targeted at local authorities. It covers their own direct role in supporting the local AFC, but also the crucial activity of convening local partnerships and so enabling effective local collaborative action. The key changes to the core infrastructure and self-assessment cover: (1) More emphasis on embedding AFC support into the mainstream of local authority work. (2) An extended top tips section with more advice based on recent research. (3) We have dropped the descriptive scenarios of challenges that members of the AFC face. These have now been overtaken by analytical scenarios included in the freely available national training material and in the Ministry of Defence’s (MoD) Covenant Legal Duty toolkit, which helps to explain the legal duty aspect of the Covenant. (4) Some additional material about the individual roles, collaboration, communication and vision and commitment elements of the core infrastructure. This toolkit update is being made in spring 2025 at a time when further change in the Covenant environment is likely, with potential extension of the Covenant duty and expected re-organisation in English local government and creation of new combined or strategic authorities. Additional modules could be added to the toolkit to reflect these ongoing policy developments.