VA

Community Living Centers in the VHA System

By Ladsine Taylor, MSN, GNP-BC, CDP

 The Veterans Health Administration (VHA) Community Living Center (CLC) is a skilled nursing home. Its mission is to restore the Veteran to his or her highest level of physical and cognitive function, prevent further declines in health, and provide comfort at the end of life – all within a Veteran-centered, home-like environment (U.S. Department of Veterans Affairs [VA], 2016a).

During the late 1990s and early 2000s, the VHA transitioned to this care model from a more medical model to keep pace with changes occurring in community nursing homes.

Under this model, CLCs reflect a home-like environment emphasizing the interaction of residents, families, and friends as much as possible. There are over 134 CLCs across the nation, including Puerto Rico, Hawaii, and Alaska.

They vary in the population they serve, services provided, and staffing. Services may include but are not limited to: access to social workers, psychologist, 24-hour skilled nursing care, restorative care, short stay rehabilitation, geriatric evaluation and management, mental health recovery care, special care for Veterans with dementia or other cognitive disorders, respite care, hospice, and palliative care for individuals at the end of life (VA, 2016a; 2016b).

VHA CLCs differ from community nursing homes. The major difference is the centralized structure of the VHA system. Whereas community nursing homes may be privately owned or part of a larger corporation, in the VHA, CLCs are part of a larger integrated healthcare system.

Residents are mostly male compared to the resident population in community nursing homes. Finally, Veterans enjoy a sense of community and camaraderie being together and sharing experiences with one another (VA, 2016a). Residents in VHA CLCs typically can have a more diverse and complex disease profile for their illness compared to residents in the community, such as amputation and traumatic brain injury.

Some services provided in CLCs may not always be found in community nursing homes such as Veteran-specific mental health care and behavioral health.

CLC care is structured based on the Holistic Approach to Transformational Change (HATCh) model. The model consists of six interrelated domains that result in personal, community, organizational, and systemwide changes necessary for the transition from institutional to individual care.

Three domains overlap in the areas of work practice, care practice, and environmental care with the Veteran resident being at the center. Surrounding these domains are leadership, community, and regulations (standards and laws). For example, rather than formal nursing stations, the model encourages facilities to be creative in designing their facility layout to allow for a home-like environment for the Veteran resident and working staff (VA, 2016a). In most traditional institutional care models, residents follow the facility’s structured program (VA, 2016b). With this cultural transformation, the HATCh model allows for mealtime flexibility and accessibility to snacks and beverages throughout the day.

Recreational activities, rehabilitation therapy, activities of daily living, and sleep schedules are centered around the Veteran’s preferences (Gourley, 2018). Emphasis is placed on assuring Veterans and their families have a voice in their care to facilitate quality of life.

Eligibility in VHA CLCs is based on clinical need and setting availability. The VHA provides CLC care depending upon eligibility criteria involving service-connected disability status, level of actual disability, and income. Veterans must have a 70% service-connected disability, or a 60% service-connected disability and be unemployable.

Veterans may also be eligible for short-stay rehabilitation services (<90 days) if they require such care for a service-connected condition. Veterans not meeting any of the criteria may be admitted based upon available resources allocated to the facility.

Veterans and their families are encouraged to consult with VHA, social workers, and case managers who may assist the individual or provider in determining possible eligibility for services in VHA CLC. To find a VA location or ask a question, call MyVA311; 844-698-2311.

Ladsine Taylor, MSN, GNP-BC, CDP
ladsinetaylor@gmail.com