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Health Systems Research

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CREATE: Long-Term Care

Director: Vincent Mor, Ph.D.

Principal Investigators:

About the CREATE

It is estimated that approximately 800,000 Veterans enrolled in VA healthcare depend on assistance with at least one activity of daily living (ADL). By 2020, more than 700,000 Veterans enrolled in VA healthcare will be over the age of 85, and most will require some kind of assistance with at least one ADL. Moreover, many other Veterans, particularly those wounded in combat, will need comprehensive long-term care (LTC).

The goal of this CREATE is to conduct research that will provide the tools, evidence, and evaluation information necessary for Geriatric and Extended Care (GEC) policymakers and staff in VHA to transform the spectrum of LTC services

  • Improve and build upon the already-strong relationship between LTC researchers and GEC leadership by providing evidence and data to inform policy and program design;
  • Ensure that results from CREATE projects are relevant to GEC operations;
  • Disseminate salient results and products as soon as possible; and
  • Accelerate construction of a specialized LTC data structure to serve the data needs of each CREATE project and the program planning needs of GEC.

Partner Offices

Each CREATE works closely with operational partners throughout the VA System. Partners for the Long-Term Care CREATE include:


This CREATE initiative includes three funded projects:

  • Medical Foster Homes: A Safe, Cost Effective Substitute for Nursing Homes? (MFH)
    The innovative MFH program serves as a VA alternative to nursing home (NH) placement for Veterans who are nursing home-eligible but prefer to receive care in a private home with qualified caregivers. This project seeks to describe characteristics of Veterans served in MFHs, how they differ from Veterans residing in NHs, and factors that lead Veterans to select or reject MFH placement over NH placement. The project will also assess Medical Foster Home safety, as well as the estimated total costs over non-MFH care for NH-eligible Veterans.
    (PI: Cari Levy, M.D., Ph.D.)
  • Implementing and Evaluating INTERACT in VA CLCs
    This study aims to implement and evaluate the INTERACT intervention, which is designed to reduce the rate of hospitalization of CLC residents. The INTERACT program focuses on nurse-physician communication, and this CREATE project has several objectives associated with this intervention, including: modifying the online INTERACT intervention training materials and testing them in selected CLCs; implementing the INTERACT intervention in at least eight CLCs for a 6-month training period and an 18-month observation period; and testing the effect of the INTERACT intervention on the rate of reduction in hospitalizations from CLC.
    (PI: Vincent Mor, Ph.D.)
  • Increasing Veterans' Use of Community-Based LTC via Timely Discharge from VA CLCs
    This project seeks to evaluate the impact of recent GEC initiatives intended to reduce length of CLC stays and readmission rates. Some of the factors that investigators will look at include: changes in and variation between facilities in CLC length of stay; utilization of VA and non-VA home and community-based services (HCBS); rates of successful discharge; and the impact of CLC characteristics and HCBS availability in the local CLC market on length of stay and successful discharge. The study also will include site visits to eight CLCs with varying lengths of stay and rates of successful discharge, in order to explore other unmeasured factors likely to be related to CLC variation.
    (PI: Susan M. Allen, Ph.D.)
  • Developing and Implementing a Toolkit for Measuring CLC Cultural Transformation
    This project seeks to strengthen the resident-centered culture of CLCs by helping CLC staff use structured observation and improvement processes to help increase positive interactions between CLC residents and staff and to help maintain an environment that constantly engages residents. Investigators will solicit detailed feedback from CLC staff about an implementation guide for two previously developed tools: the Resident-centered Assessment of Interactions with Staff and Engagement (RAISE) tool, a standardized, observation-based tool to measure CLC resident-staff interactions and resident engagement, and the Advancing Cultural Transformation in Our Neighborhoods! Plan (ACTION! Plan) an action-oriented protocol to help busy frontline staff adopt resident-centered care improvements. The study goals will be accomplished in 3 phases, where Phase I involves phone interviews and site visits to refine the tools and develop the implementation guide, which will include a training video and detailed instructions; Phase II involves piloting the implementation guide and tools at 6 CLCs; and Phase III involves finalizing and disseminating the implementation guide and tools in CLCs nationwide.
    (PI: Christine W. Hartmann, Ph.D.)

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