Optimizing Function and Independence Through iHI-FIVES

Background/Purpose. Although the VHA has the most extensive system of home and
community-based services, most Veterans who need care in their home receive it exclusively
through family and friends. For Veterans living with cognitive and/or functional limitations,
even though family or friend caregivers help avoid or delay nursing home entry, caregivers
are faced with a greater risk of depression and burnout. These caregivers often lack training
and support needed to perform high-quality caregiving duties, and critical gaps remain in
VA-system wide approaches to addressing caregiver skills training and support.

iHI-FIVES is an evidence-based skills training program for family or friend caregivers of
Veterans referred to home care services. iHI-FIVES is adapted from a randomized control trial
(HI-FIVES) funded by the VHA Office of Research and Development and conducted at the Durham
VAMC with evaluation results shown to increase satisfaction with VHA care and reduce
caregiver feelings of isolation. The iHI-FIVES curriculum that will be delivered by clinical
staff consists of four in-person group classes that address caregiver clinical,
psychological, and support-seeking skills.

iHI-FIVES is part of the investigators' Optimizing Function and Independence QUERI (the other
sub-project is STRIDE QUX-16-015). For the iHI-FIVES sub-project, the investigators plan to
implement the iHI-FIVES caregiver skills training program (hereafter called "clinical
program") at 8 VAMC sites in a stepped-wedge design with sites randomized to implementation
strategy and start date.

Objectives. The investigators plan to conduct an evaluation to examine the impact of
iHI-FIVES on patient independence and caregiver functioning.

Key questions: Do patients have higher number of days in the community following iHI-FIVES
implementation? Do caregivers have higher satisfaction with VA care, lower depressive
symptoms and lower subjective burden following IHI-FIVES implementation? What is the value of
iHI-FIVES from the caregiver's perspective? The investigators also plan to conduct a mixed
method evaluation that examines implementation outcomes and provider team experience that
will not be reported here.

Methodology. For patients referred to home care services, the investigators will compare the
number of days in the community before and after the iHI-FIVES program is implemented
(approx. n=400). In addition, the investigators will compare a subset of caregivers of
Veterans referred to home care services before and after the iHI-FIVES program is implemented
to assess satisfaction with VA care, depressive symptoms, and subjective burden.

Inclusion Criteria:

Inclusion for patients is a consult or referral in the past three months from the date of
the data pull to the following VA services:

- Homemaker home health aide services

- Home based primary care

- Adult day health care

- Respite care

- Veteran directed care

Inclusion here apply to subset of caregivers providing consent for telephone interviews:

- Able and willing to provide informed consent

Exclusion Criteria:

Exclusion for patients is a consult or referral in the past three months from the date of
the data pull to the following VA services:

- Hospice care

Exclusion here apply to subset of caregivers providing consent for telephone interviews:

- Difficulty with or unable to communicate on the telephone, or no telephone access

- Caregiver is a professional without pre-existing personal relationship with Veteran
patient and receives payment for caregiving services (e.g. formal care provider)

- Their care recipient (the Veteran) is currently in hospital or institution

- Their care recipient (the Veteran) is currently receiving hospice care

- Caregiver is a member of the Durham HSR&D Veteran and Family Input Initiative (VAFII),
where members have advised and provided input towards the development of iHI-FIVES
intervention materials