DESCRIPTION (provided by applicant): The Program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the VA National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. Four projects, all focused on improving the provision of veteran-centered care, are proposed. The projects will be conducted in Community Living Centers (VA owned nursing homes) and Home Based Primary Care Programs in five regional networks in the Veterans Health Administration. They are all designed to support a new program to ask Veterans in these settings about their preferences for care, particularly health care services and interventions that are typically used i the event of a life threatening emergency, or life-sustaining measures. These measures include, but are not limited to, cardiac resuscitation, mechanical ventilation, and other forms of life support. However, Veteran preferences for care go beyond whether or not they receive life sustaining treatments, and include whether or not they want to be hospitalized if they are acutely ill, what kinds of comfort care they would like to receive, and what kinds of physical activity they would like to experience, even near the end of life. The four projects are all planne as quality improvement projects. Two focus on implementing new approaches to asking about preferences for care and making sure that these preferences are documented where everyone providing care to a Veteran can find them. One focuses on getting this new approach implemented in Community Living Centers, and the other focuses on similar work among teams of care providers who go into Veterans' homes to provide care there. Both follow up with staff in these settings to make sure that Veterans' expressed preferences are incorporated into the services they receive. The other two projects focus on how to improve care for Veterans with dementia, such as Alzheimer's Disease, and on how to increase the amount of physical activity Veterans are offered when they are near the end of life and living either in a Community Living Center or at home receiving services from the VA. In all the projects, we will use information to design feedback reports for staff to help them understand how well they are meeting expectations in terms of asking Veterans about their preferences, and documenting them as expected. We will also use what are called "learning collaboratives"-meetings in which staff teams come together and problem-solve issues they encounter in how to get Veterans' preferences expressed and documented, as well as how to make sure that those preferences are acted on. We will use data over time to see whether there are improvements following the work we do. We will work with our operational partners to spread approaches that work throughout the Veterans Health Administration.