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（HHAS）提高VA的优先事项，以纪念退伍军人对年龄的渴望 改善健康状况，减少家庭护理人员的燃烧和压力，并延迟或避免昂贵 机构安置。缺乏足够的，稳定的HHA支持对老年退伍军人的支持与孤独感有关， 抑郁和死亡率。改善HHA服务的访问是紧急的VA和立法优先事项，VA的优先权 HHA福利是卫生系统最广泛使用和增长最快的家庭和社区服务 （HCB）。但是，由于HHA护理是从社区提供者那里购买的，因此导航护理可能很复杂，并且 分散。因此，确保稳定，连续的HHA护理需要采用利益相关者参与的系统方法 更好地了解退伍军人如何导航障碍并确定个人的潜在干预措施， 组织和政策级别。我对HHA和我的专业研究和专业经验 定性培训为这项工作做好了准备。通过精通过程和进一步改进的培训， 干预开发，实施科学和试验设计，我将把这一CDA的发现纳入 一堆可操作的多层次干预措施，并推进了我的VA职业。 具体目的：该提议的CDA只是填补了我的培训中的空白，并为VA提供了严格的 研究未来干预措施以加强家庭中退伍军人的护理团队的研究。这 工作以理论驱动的框架为指导，并由GEC的运营合作伙伴提供支持 支持和初级保健。目标将：（1）系统地描述接收和维护VA-的过程 通过确定步骤付费HHA服务；个人，组织和政策级别的障碍；并承诺 干预点。 （2）协作适应VA的既定护理人员第一家庭护理人员课程 对于VA付费HHA。 （3）对布朗克斯VA的干预措施进行试点和形成性评估。 方法：AIM 1：在地理，大小和HHA益处结构上，在4个VAMCS潜水员中，我将创建流程 使用退伍军人，护理人员，VA初级保健团队，VA HCBS协调员使用参与方法的地图， 家庭健康机构和HHA优先考虑可能修改的组织因素以改善HHA 使用权。 AIM 2：通过利益相关者参与的共同设计流程，以前的飞行员数据和 在AIM 1中确定的需求和障碍，我将制定一种干预措施，以更好地准备HHA，以提供资深人士 - 中心护理。目标3：我将使用混合方法评估实施结果（可行性，可接受性， 有用性）和HHA结果（准备）。我还将检查潜在的下游措施（护理人员 伯恩，在家的资深日子）。 预期结果和下一步：在整个研究中，我将为我的运营合作伙伴提供关键 可交付成果，包括组织级干预措施的HHA过程图和优先事项，以及可扩展的， 利益相关者设计的VA付费HHA的培训计划。通过此CDA发展的知识和技能 将帮助我开发多站点研究，以更严格地评估这种干预的有效性和 通过两个拟议的多站点IIR来解决个人和组织级的干预措施。调查结果会 告知未来的研究和行动，以提高HHA服务的交付和稳定性并利用技能 这个关键的劳动力。 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，并且对VA和响应敏感 立法优先事项。它解决了长期护理/衰老和残疾的多个HSR＆D优先领域， 专注于卫生系统问题和横切HSR方法，并阐明了一个关键的尚未理解的 VA HCB的锚。由于长期护理转移到社区，这项工作正处于弗吉尼亚州的关键时刻。 这项研究抓住了这些机会，系统地确定了所需的改进并启动 有希望的干预措施是利用VA资源来支持退伍军人护理团队的第一步。