Maximizing the Value of VA Homemaker/Home Health Aide (H/HHA) Services to Veterans, Caregivers and VA: Supporting Older Veterans’ Pathways to Stable H/HHA Care

最大限度地发挥 VA 家庭主妇/家庭健康助理 (H/HHA) 服务对退伍军人、护理人员和 VA 的价值：支持老年退伍军人 — 获得稳定 H/HHA 护理的途径

• 批准号: 10638592
• 负责人: Emily C. Franzosa
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10638592
• 关键词: Address; Advisory Committees; Affect; Aging; Area; Bathing; Caregiver Burden; Caregiver support; Caregivers; Caring; Case Management; Communities; Complex; Contracts; Data; Eating; Educational Curriculum; Effectiveness of Interventions; Emotional; Ensure; Evidence based intervention; Family Caregiver; Future; Geography; Goals; Health; Health system; Home; Home Health Agency; Home Health Aides; Homogeneously Staining Region; Household; Hybrids; Improve Access; Individual; Institution; Intervention; Knowledge; Light; Loneliness; Long-Term Care; Maps; Measures; Mental Depression; Mentors; Mentorship; Methodology; Methods; Outcome; Pathway interactions; Policies; Primary Care; Process; Provider; Quality of life; Readiness; Research; Research Personnel; Resources; Services; Site; Standardization; Structure; System; Testing; Training; Training Programs; Variant; Veterans; Work; aging in place; career; caregiver strain; caregiving; community based service; coping; cost; design; disability; effectiveness evaluation; evidence base; experience; formative assessment; home based service; implementation evaluation; implementation outcomes; implementation science; improved; innovation; mortality; prevent; primary care team; process improvement; research study; skills; social; theories; therapy design; therapy development; trial design

Background: Home health aides (HHAs) advance VA’s priority to honor Veterans’ desire to age in place by improving health outcomes, reducing family caregiver burden and strain, and delaying or avoiding costly institutional placement. Lack of adequate, stable HHA support for older Veterans is associated with loneliness, depression and mortality. Improving access to HHA services is an urgent VA and legislative priority, and VA’s HHA benefit is the health system’s most widely used and fastest growing home and community-based service (HCBS). But because HHA care is purchased from community providers, navigating care can be complex and fragmented. Ensuring stable, continuous HHA care thus demands a stakeholder-engaged systems approach to better understand how Veterans navigate roadblocks and to identify potential interventions at the individual, organizational and policy levels. My extensive research and professional experience with HHAs and my qualitative training prepares me for this work. With mentorship and additional training in process improvement, intervention development, implementation science, and trial design, I will leverage this CDA’s findings into a bundle of actionable, multi-level interventions and advance my VA career. Specific Aims: This proposed CDA simultaneously fills the gaps in my training and provides VA with rigorous research on which to ground future interventions to strengthen Veterans’ caregiving teams in the home. This work is guided by a theory-driven framework and supported by operational partners in GEC, Caregiver Support, and Primary Care. Aims will: (1) Systematically describe the process of receiving and maintaining VA- paid HHA services by identifying steps; individual, organizational and policy-level roadblocks; and promising points of intervention. (2) Collaboratively adapt VA’s established Caregivers FIRST family caregiver curriculum for VA-paid HHAs. (3) Conduct a pilot and formative evaluation of the intervention at the Bronx VA. Methods: Aim 1: At 4 VAMCs diverse in geography, size, and HHA benefit structure, I will create process maps using participatory methods with Veterans, caregivers, VA primary care teams, VA HCBS coordinators, home health agencies and HHAs to prioritize potentially modifiable organizational factors to improve HHA access. Aim 2: Through a stakeholder-engaged co-design process informed by previous pilot data and the needs and barriers identified in Aim 1, I will develop an intervention to better prepare HHAs to provide Veteran- centered care. Aim 3: I will use mixed methods to assess implementation outcomes (feasibility, acceptability, usefulness) and HHA outcomes (preparedness). I will also examine potential downstream measures (caregiver burden, Veteran days at home). Expected Results and Next Steps: Throughout this study, I will provide my operational partners with key deliverables, including HHA process maps and priorities for organizational-level interventions, and a scalable, stakeholder-designed training program for VA-paid HHAs. Knowledge and skills developed through this CDA will help me develop multi-site studies to more rigorously evaluate the effectiveness of this intervention and address individual and organizational-level interventions through two proposed multi-site IIRs. Findings will inform future research and action to improve the delivery and stability of HHA services and leverage the skills of this critical workforce. Significance and Relevance to Veterans’ Health: My study is innovative, timely, and responsive to VA and legislative priorities. It addresses multiple HSR&D priority areas in Long-term Care/Aging and Disability, with a focus on health systems issues and cross-cutting HSR methods, and shines light on a critical yet understudied anchor of VA HCBS. This work comes at a critical juncture for VA as long-term care shifts to the community. This study seizes these opportunities, systematically identifying needed improvements and launching a promising intervention as a first step toward leveraging VA resources to support Veterans’ caregiving teams.

背景：家庭健康助手(HHA)推动退伍军人管理局优先考虑退伍军人通过以下方式实现老龄化的愿望 改善健康状况，减轻家庭照顾者的负担和压力，推迟或避免昂贵的费用 机构安置。缺乏对老年退伍军人足够、稳定的HHA支持与孤独有关， 抑郁症和死亡率。改善卫生保健服务的可获得性是退伍军人事务部和立法的当务之急，退伍军人事务部的 HHA福利是卫生系统中使用最广泛、增长最快的基于家庭和社区的服务 (HCBS)。但由于HHA护理是从社区提供者那里购买的，导航护理可能会很复杂 支离破碎。因此，确保稳定、持续的HHA护理需要利益相关者参与的系统方法来 更好地了解退伍军人如何通过路障并确定个人的潜在干预措施， 组织和政策层面。我广泛的研究和专业经验与他和我的 质量培训使我为这项工作做好了准备。通过指导和流程改进方面的额外培训， 干预开发、实施科学和试验设计，我将利用此CDA的发现 捆绑可操作的、多层次的干预措施，推进我的退伍军人管理局职业生涯。 具体目标：建议的CDA同时填补了我培训中的空白，并为退伍军人管理局提供了严格的 研究未来的干预措施，以加强退伍军人在家中的照顾团队。这 工作由理论驱动的框架指导，并得到GEC、Caregiver的运营合作伙伴的支持 支持和初级保健。AIMS将：(1)系统地描述接收和维护VA的过程- 通过确定步骤；个人、组织和政策层面的障碍；以及承诺，付费HHA服务 干预点。(2)协作调整退伍军人管理局既定的照顾者第一家庭照顾者课程 为退伍军人管理局支付的费用。(3)对布朗克斯退伍军人管理局的干预措施进行试点和形成性评估。 方法：目标1：在地理、规模和HHA利益结构不同的4个VAMC中，创建流程 与退伍军人、照顾者、退伍军人初级保健团队、退伍军人保健服务协调员、 家庭健康机构和HHA应优先考虑可能可更改的组织因素，以改善HHA 进入。目标2：通过利益攸关方参与的联合设计过程，了解以前的试点数据和 在目标1中确定的需求和障碍，我将制定干预措施，以更好地为HHA提供退伍军人- 集中护理。目标3：我将使用混合方法评估执行成果(可行性、可接受性、 有用性)和HHA结果(准备情况)。我还将检查潜在的下游措施(护理者 负担，老兵在家里的日子)。 预期结果和下一步：在整个研究过程中，我将向我的运营合作伙伴提供关键的 可交付成果，包括HHA流程图和组织级干预的优先事项，以及可扩展、 利益相关者为退伍军人事务部设计的培训计划。通过本CDA开发的知识和技能 将帮助我开展多点研究，以更严格地评估这种干预的有效性，并 通过两个拟议的多地点IIR解决个人和组织一级的干预措施。调查结果将 告知未来的研究和行动，以改进HHA服务的交付和稳定性，并利用这些技能 这支关键的劳动力队伍。 对退伍军人健康的意义和相关性：我的研究是创新的，及时的，并对退伍军人健康和 立法优先事项。它解决了长期护理/老龄化和残疾方面的多个高铁与研发优先领域，具有 关注卫生系统问题和交叉的高铁方法，并阐明一个关键但未被研究的问题 VA HCBS的锚。这项工作是在退伍军人管理局将长期护理转移到社区的关键时刻进行的。 这项研究抓住了这些机会，系统地确定了需要改进的地方，并启动了 承诺进行干预，作为利用退伍军人管理局资源支持退伍军人护理团队的第一步。