Caregiving, Functional Impairment
Conditions
Keywords
dissemination
Brief summary
Veteran-Directed Home and Community Based Services (VD-HCBS) is focused on preserving Veteran's independence and the VA Office of Geriatrics and Extended Care is planning an expansion of VD-HCBS to 90 additional VA Medical Centers over the next 3 years. This proposal seeks to evaluate the VD-HCBS expansion to capture comprehensive information on the impact of VD-HCBS on Veterans' and Caregivers' outcomes, as well as, to identify how the program was implemented.
Detailed description
In the next decade, there will be a doubling of older Veterans for whom the VA has a requirement to provide long-term care. At a cost of $110,000 per year for long-term care, Geriatrics and Extended Care (GEC) is seeking to preserve Veteran independence in the community. VD-HCBS is a person-centered consumer-directed program that provides Veterans the opportunity to self-direct their long-term services and supports (LTSS) and continue to live independently at home. GEC is planning to expand VD-HCBS to an additional 90 VAMCs over the next 3 years. This proposal will provide important outcomes and context to the VD-HCBS expansion. The specific aims of this proposal are: Aim 1: To describe the impact of VD-HCBS on Veterans' satisfaction, unmet need for services, quality of life and independence using mixed methods. Aim 1 will utilize operations data to describe the change in Veteran-reported satisfaction, unmet needs, and independence from enrollment in VD-HCBS to 3 and 12 months. Additionally, the investigators will conduct interviews with Veterans to capture their experiences with the program. Aim 2: To understand the effect of VD-HCBS on Caregivers' well-being. Aim 2 will compare Caregivers' financial strain, depressive symptoms, caregiving stress, and health status and positive caregiver experiences to a propensity matched population from existing VA data to determine the impact of the VD-HCBS program on Caregivers. Aim 3: To examine the implementation of the VD-HCBS program expansion. Aim 3 will utilize the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change to interview coordinators, and other key informants, from VA and ADNA VD-HCBS pairs. The analysis will shed light on how contextual factors and implementation strategies relate to implementation and Veteran outcomes. VD-HCBS has tremendous opportunity to improve the fiscal outlook of GEC's LTSS while delivering the highest level of Veteran-centered care. In concert with the outcomes of VD-HCBS, this implementation evaluation will be critical to determining how the VA system, in partnership with community-based organizations, implements programs and illuminating important leverage points to facilitate implementation effectiveness. With the diverse team assembled and the comprehensive evaluation proposed, the investigators will produce evidence to inform VA program implementation and dissemination, a critical component of the VA's priorities to develop high-performing, highly-reliable, and consistent networks.
Interventions
OTHERVD-HCBS
Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease
Sponsors
US Department of Veterans Affairs
Department of Health and Human Services
VA Office of Research and Development
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Veterans who are eligible and enrolled in VD-HCBS at the expansion VAMCs
Exclusion criteria
* Non-Veterans * Those not eligible or enrolled in VD-HCBS * Enrolled in VD-HCBS at a non-expansion VAMC
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Veteran's Unmet Need for Services, Satisfaction, Unmet Needs, and Quality of Life. | 12 months | Satisfaction Survey Number of Veterans responding to VA-specific program survey questions on Veteran satisfaction, unmet needs, and quality of life. Veterans were asked to respond to a 6 question survey by choosing a number from a scale (either from 1-10 or 1-5; low numbers typically indicating satisfaction; higher numbers indicating dissatisfaction) to indicate their level of overall satisfaction with their current health needs and ability to participate in daily activities. |
| Caregiver Well-being Survey | 9 months | Number of caregivers who responded to a VA specific Caregiver survey on financial strain, depressive symptoms, caregiving stress, and health status and positive caregiver experiences. Caregivers were asked to choose the best answer from a scale that reflected the level of intensity (low numbers typically indicating less intensity than the higher numbers) of common caregiving stressors. |
Countries
United States
Participant flow
Recruitment details
Recruitment letters to Veterans, Caregivers and Coordinators were sent inviting them to participate in qualitative interviews.
Participants by arm
| Arm | Count |
|---|---|
| Veterans Veterans will be the primary group for whom the VD-HCBS Program is implemented. Veterans enrolled in VD-HCBS will be functionally impaired
VD-HCBS: Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease | 99 |
| Caregivers Caregivers support Veterans independence in their home and community
VD-HCBS: Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease | 8 |
| VHA Coordinators VHA VD-HCBS Coordinators allow the program to operate within the VA
VD-HCBS: Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease | 10 |
| ADNA Coordinators ADNA Coordinators engage with the Veteran, Caregivers, and VA Coordinators to ensure the Veteran is able to maintain independence
VD-HCBS: Like the participant-directed programs developed for Medicaid programs,VD-HCBS maximizes Veteran-centered care and independence. VD-HCBS provides Veterans with a monthly financial allotment based on an assessment of the extent of their need for assistance with personal care due to injury or the impact of disease | 9 |
| Total | 126 |
Baseline characteristics
| Characteristic | Veterans | Total | Caregivers | ADNA Coordinators | VHA Coordinators |
|---|---|---|---|---|---|
| Age, Continuous | 75.4 years STANDARD_DEVIATION 13.6 | 74.4 years STANDARD_DEVIATION 14.1 | 63 years STANDARD_DEVIATION 12 | — | — |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | — | — |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 99 Participants | 107 Participants | 8 Participants | — | — |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | — | — |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants | 3 Participants | 0 Participants | — | — |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | — | — |
| Race (NIH/OMB) Black or African American | 37 Participants | 38 Participants | 1 Participants | — | — |
| Race (NIH/OMB) More than one race | 1 Participants | 1 Participants | 0 Participants | — | — |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | — | — |
| Race (NIH/OMB) Unknown or Not Reported | 6 Participants | 7 Participants | 1 Participants | — | — |
| Race (NIH/OMB) White | 52 Participants | 58 Participants | 6 Participants | — | — |
| Region of Enrollment United States | 99 Participants | 126 Participants | 8 Participants | 9 Participants | 10 Participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants | — | — |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants | — | — |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 99 | 0 / 8 | 0 / 10 | 0 / 9 |
| other Total, other adverse events | 0 / 99 | 0 / 8 | 0 / 10 | 0 / 9 |
| serious Total, serious adverse events | 0 / 99 | 0 / 8 | 0 / 10 | 0 / 9 |
Outcome results
Primary
Caregiver Well-being Survey
Number of caregivers who responded to a VA specific Caregiver survey on financial strain, depressive symptoms, caregiving stress, and health status and positive caregiver experiences. Caregivers were asked to choose the best answer from a scale that reflected the level of intensity (low numbers typically indicating less intensity than the higher numbers) of common caregiving stressors.
Time frame: 9 months
Population: Caregivers who participated in a caregiver well-being survey.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Veterans | Caregiver Well-being Survey | Reported Poor Health | 0 Participants |
| Veterans | Caregiver Well-being Survey | Serious Economic Situation | 4 Participants |
| Veterans | Caregiver Well-being Survey | Stressed between caregiving and other responsibili | 3 Participants |
| Veterans | Caregiver Well-being Survey | Felt lonely or isolated | 5 Participants |
Primary
Veteran's Unmet Need for Services, Satisfaction, Unmet Needs, and Quality of Life.
Satisfaction Survey Number of Veterans responding to VA-specific program survey questions on Veteran satisfaction, unmet needs, and quality of life. Veterans were asked to respond to a 6 question survey by choosing a number from a scale (either from 1-10 or 1-5; low numbers typically indicating satisfaction; higher numbers indicating dissatisfaction) to indicate their level of overall satisfaction with their current health needs and ability to participate in daily activities.
Time frame: 12 months
Population: Veterans enrolled in the Veteran Directed Home and Community Based Services program.~Six Veterans did not participate in the survey.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Veterans | Veteran's Unmet Need for Services, Satisfaction, Unmet Needs, and Quality of Life. | 1. Satisfaction of VA home services | 71 Participants |
| Veterans | Veteran's Unmet Need for Services, Satisfaction, Unmet Needs, and Quality of Life. | 2. Need additional help with everyday activities | 63 Participants |
| Veterans | Veteran's Unmet Need for Services, Satisfaction, Unmet Needs, and Quality of Life. | 3. Able to attend recreational/social activities | 35 Participants |
| Veterans | Veteran's Unmet Need for Services, Satisfaction, Unmet Needs, and Quality of Life. | 4. Worry about being able to remain in home | 39 Participants |
| Veterans | Veteran's Unmet Need for Services, Satisfaction, Unmet Needs, and Quality of Life. | 5. Enough choice for services and products | 66 Participants |
| Veterans | Veteran's Unmet Need for Services, Satisfaction, Unmet Needs, and Quality of Life. | 6. General life satisfaction | 60 Participants |