Projected use of long-term-care services by enrolled Veterans.
OBJECTIVE
The purpose of this article is to describe the projected use for long-term-care services through 2012.


METHODS
We constructed a static-component projection model using age, function, and other covariates. We obtained enrollee projections from the Veterans Health Administration (VHA) and combined these with nursing home and community long-term-care service use rates from the 1999 National Long-Term Care Survey and the 2000 National Health Interview Survey.


RESULTS
Over the next decade, the number of oldest veterans (aged 85+) will double, and VHA-enrolled veterans aged 85 and older will increase sevenfold. This will result in a 20-25% increase in use for both nursing home and home- and community-based services. VHA currently concentrates 90% of its long-term-care resources on nursing home care. However, among those who receive long-term care from all formal sources, 56% receive care in the community. Age and marital status are significant predictors of use of either type of formal long-term-care service for any given level of disability. VHA's experience with the mandatory nursing home benefit suggests that even when the cost to the veteran is near zero, only 60-65% of eligibles will choose VHA-provided care. Assisted living represents nearly 15% of care provided during the past decade to individuals in nursing homes, and approximately 19% of veterans using nursing homes have disability levels comparable to those of men supported in assisted living.


CONCLUSIONS
As most of the increased projected use for long-term care will be for home- and community-based services, VHA will need to expand those resources. Use of VHA resources to leverage community services may offer new opportunities to enhance community-based long-term care.
Kinosian
Bruce
B
Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA 19104, USA. brucek@mail.med.upenn.edu
Stallard
Eric
E
Wieland
Darryl
D
D000368:Aged; D000369:Aged, 80 and over; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D009735:Nursing Homes / Q000706:statistics & numerical data; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*