CARING FOR OLDER PATIENTS WITH COMPLEX PROBLEMS: CHALLENGES, STRATEGIES, AND THE VETERANS HEALTH ADMINISTRATION EXPERIENCE

An aging population with complex and interacting medical, functional, psychosocial, and behavioral concerns poses a challenge for our healthcare systems and healthcare policy. A small percentage of patients accounts for most health care spending in the United States, including in the Veterans Health Administration (VHA). In VHA, particular concern has focused on aging Veterans with medical, neurocognitive, and/or mental disorder comorbidities whose behaviors may be disruptive to care. These behaviors may put patients at risk for harm to self or others and lead to inefficient, ineffective, or inappropriate use of resources. This session aims to engage participants in considering varying definitions of patients with complex needs, and how VHA has worked to understand these needs, identify promising practices, and prepare a workforce capable of meeting these needs. In the first presentation, the presenter will discuss varying conceptualizations of “complex patients” and related challenges for targeted program development and dissemination. An overview of the development, activities, and plans for the VHA Care for Patients with Complex Problems Program will be presented. The audience will be engaged in discussing the challenges for providing geriatric behavioral care across inpatient mental health, nursing home, and rehabilitation care settings, and VHA efforts to develop guidance for teams wishing to enhance capacity to provide geriatric behavioral care in these settings will be shared. A unique program, the Behavioral Recovery Outreach (BRO) Team, that facilitates transitions of care for Veterans with complex behavioral needs from inpatient nursing care to community-based care settings will be described. A closing discussion with the audience will center around the next steps in policy and program development and evaluation needed to meet the needs of aging population with complex care needs.