JMIR Publications

ABSTRACT

Background:

The Veteran-Directed Care (VDC) program serves to assist Veterans at risk of long-term institutional care to remain at home by providing funding to hire Veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) medical centers (VAMCs) and third-party aging and disability network agency (ADNA) providers.

Objective:

Our aims are to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in one region: Veteran Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also want to understand leadership and stakeholder perspectives on VDC programs’ reach and implementation, and to describe Veterans served by the VISN 8 VDC programs and their home and community-based service use. Finally, we want to compare Veterans served by VDC programs in VISN 8 to the Veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and make recommendations to guide VDC program expansion in VISN 8.

Methods:

The mixed-methods study design encompasses electronically delivered surveys, semi-structured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR 2.0). Participants included staff of VAMCs and partnering ADNAs across VISN 8, leadership at these VAMCs and VISN 8, Veterans enrolled in VDC and Veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a pre-interview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR 2.0 framework. Participants will complete a semi-structured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site.

Results:

We will calculate descriptive statistics including means, standard deviations, and percentages for survey responses. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be compared to national implementation, helping identify program recommendations and strategies for VDC expansion. We will use administrative data to describe Veterans served by the programs in VISN 8 and nationally.

Conclusions:

The VA has prioritized VDC rollout nationally and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of staff, leadership, Veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery and facilitate growth within VISN 8 and inform new program establishment at other sites nationally as the VDC program expands.