Medical Foster Homes: Can the Adult Foster Care Model Substitute for Nursing Home Care?

OBJECTIVE: To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs.

DESIGN: Descriptive, unmatched study.

SETTING: VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs).

PARTICIPANTS: Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011.

MEASUREMENTS: Using VA and Medicare data from fiscal years 2010 and 2011, demographic characteristics, healthcare use, and costs of 388 veterans in MFHs were compared with 26,037 of those in HBPC, 5,355 in CLCs, and 5,517 in CNHs in the year before and the year after enrollment.

RESULTS: Veterans enrolled in the MFH program were more likely to be unmarried than those in other LTC programs and had higher levels of comorbidity and frailty than veterans receiving HBPC but had similar levels of comorbidity, frailty, and healthcare use as those in CLCs and CNHs. MFH veterans incurred lower costs than those in CNHs and CLCs.

CONCLUSION: MFHs served a distinct subset of veterans with levels of comorbidity and frailty similar to those of veterans cared for in CLCs and CNHs at costs that were comparable to or lower than those of the VHA. Propensity-matched comparisons will be necessary to confirm these findings.