title: Shared Homes as an Alternative to Nursing Home Care: Impact of VA's Medical Foster Home Program on Hospitalization.
abstract: OBJECTIVE
  This study compares hospitalization rates for common conditions in the Veteran Affairs (VA) Medical Foster Home (MFH) program to VA nursing homes, known as Community Living Centers (CLCs).
  
  
  METHODS
  We used a nested, matched, case control design. We examined 817 MFH residents and matched each to 3 CLC residents selected from a pool of 325,031. CLC and MFH cases were matched on (a) baseline time period, (b) follow-up time period, (c) age, (d) gender, (e) race, (f) risk of mortality calculated from comorbidities, and (g) history of hospitalization for the selected condition during the baseline period. Odds ratio (OR) and related confidence interval (CI) were calculated to contrast MFH cases and matched CLC controls.
  
  
  RESULTS
  Compared with matched CLC cases, MFH residents were less likely to be hospitalized for adverse care events, (OR = 0.13, 95% CI = 0.03-0.53), anxiety disorders (OR = 0.52, 95% CI = 0.33-0.80), mood disorders (OR = 0.57, 95% CI = 0.42-0.79), skin infections (OR = 0.22, 95% CI = 0.10-0.51), pressure ulcers (OR = 0.22, 95% CI = 0.09-0.50) and bacterial infections other than tuberculosis or septicemia (OR = 0.54, 95% CI = 0.31-0.92). MFH cases and matched CLC controls did not differ in rates of urinary tract infections, pneumonia, septicemia, suicide/self-injury, falls, other injury besides falls, history of injury, delirium/dementia/cognitive impairments, or adverse drug events. Hospitalization rates were not higher for any conditions studied in the MFH cohort compared with the CLC cohort.
  
  
  CONCLUSIONS
  MFH participants had the same or lower rates of hospitalizations for conditions examined compared with CLC controls suggesting that noninstitutional care by a nonfamilial caregiver does not increase hospitalization rates for common medical conditions.
authors.affiliation: Department of Internal Medicine, Palliative Care, Veterans Affairs Medical Center Eastern Colorado Health Care System, Denver.
authors.forename: Cari R
authors.initials: CR
authors.lastname: Levy
authors.affiliation: Department of Health Administration and Policy, George Mason University, Fairfax Virginia. Office of Chief of Staff, District of Columbia Veterans Affairs Medical Center, Washington DC. falemi@gmu.edu.
authors.forename: Farrokh
authors.initials: F
authors.lastname: Alemi
authors.affiliation: Bay Pines Veterans Administration Healthcare System, Florida.
authors.forename: Allison E
authors.initials: AE
authors.lastname: Williams
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, James A Haley Veterans Administration Medical Center, Tampa, Florida.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Williams
authors.affiliation: Department of Health Administration and Policy, George Mason University, Fairfax Virginia.
authors.forename: Janusz
authors.initials: J
authors.lastname: Wojtusiak
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, James A Haley Veterans Administration Medical Center, Tampa, Florida.
authors.forename: Bryce
authors.initials: B
authors.lastname: Sutton
authors.affiliation: Department of Health Administration and Policy, George Mason University, Fairfax Virginia.
authors.forename: Phan
authors.initials: P
authors.lastname: Giang
authors.affiliation: Department of Health Administration and Policy, University of South Florida, Tampa.
authors.forename: Etienne
authors.initials: E
authors.lastname: Pracht
authors.affiliation: Bay Pines Veterans Administration Healthcare System, Florida.
authors.forename: Lisa
authors.initials: L
authors.lastname: Argyros
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000628:therapy*; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D016017:Odds Ratio; D015397:Program Evaluation; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Caregiving-formal; Caregiving-informal; Hospitalization; Matched case control evaluation; Nursing home care