Improving Post-Acute Care Decision-Making Processes for Older Veterans

Key Takeaways:

• Consistent post-acute care is a growing need for older veterans. US Department of Veterans Affairs (VA) operational leaders agree that when deciding on care options, veterans should be well-informed, empowered, and supported by VA and health care professionals.
• Some barriers that impede veteran-centered decision-making include a lack of tools and procedures, limited physician knowledge, inefficient tracking and feedback systems, and complex post-acute care options.
• Improving systems that measure veteran outcomes and gather feedback can help improve post-acute care for veterans.

With over 200 000 hospitalized veterans discharged to skilled nursing facilities each year, post-acute care is a significant aspect of veteran care. However, current decision-making processes surrounding post-acute care are suboptimal.

Researchers held a series of interviews with VA operational leaders to analyze the VA’s views on the value of post-acute care services, decision-making processes, gaps in care, and areas to improve these processes for older veterans.

A total of 18 VA operational leaders were interviewed: 8 physicians, 3 nurses, 3 social workers, 2 nurse practitioners, 1 urban policy master, and 1 PhD participant. Two of the participants were veterans over 65 years old, giving unique perspectives and targeted insights.

The Value and State of Post-Acute Care Decision-Making for Veterans

Many of the interviewees stressed the importance of post-acute care, especially as the number of older veterans continues to increase. Post-acute care often marks the beginning of long-term care and allows for a smoother transition into skilled nursing facilities or home care services.

Ideally, conversations surrounding post-acute care would center on veteran values and goals. Veterans and their families should be informed of care options and resources available to them, and decisions should match the preferences and goals of veterans.

Unfortunately, multiple barriers prevent the implementation of veteran-centered processes. Current systems lack appropriate tools and guidelines to inform decision processes. Physicians have a limited knowledge of the options available to veterans. There is no sufficient system for tracking veteran outcomes or receiving feedback. The VA has not standardized post-acute care, making choices more complicated for veterans.

Many interviewees recommended measuring outcomes to enhance post-acute care for veterans. In order to improve decision-making processes, the VA should assess veteran and clinician satisfaction, quality of life, workflows, and care access.

The study’s authors said, “These findings can be used to further identify new target points for redesigning care, develop high-impact interventions, and establish evidence-based practice guidelines to improve post-acute care transitions.”

Reference

Piazza KM, Benson J, Pascal C, Hausmann LRM, Schapira MM, Burke RE. Gaps and opportunities to improve post-acute care decision-making for older veterans: insights from Veterans Affairs national leaders. J Am Med Dir Assoc. 2026;27(1):105967. doi:10.1016/j.jamda.2025.105967