Evaluation of Veteran-Directed Home and Community Based Services

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.

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