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Health Services Research & Development

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2015 HSR&D/QUERI National Conference Abstract

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3109 — Housing Our Heroes: Facilitators to Growth of VA Medical Foster Home Programs

Haverhals LM, Denver VAMC; Manheim C, Denver VAMC; Jones J, University of Colorado Denver, Denver VAMC; Levy CR, Denver VAMC;

Objectives:
The Veterans Health Administration (VHA) Medical Foster Home (MFH) program launched in 1999 and serves as an alternative to nursing home care for eligible Veterans who reside in private homes of 24-hour caregivers. In-home medical care is provided by VHA's interdisciplinary Home Based Primary Care (HBPC) teams. To date there are over 100 MFH programs nationally serving over 2,500 Veterans. The objectives of this study are to understand key factors that have contributed to growth of MFH programs nationally.

Methods:
In-person individual interviews and focus groups were conducted with MFH program coordinators, MFH program support assistants (PSAs), and HBPC team members during site visits to three larger MFH programs across the country. Thirty-nine participants were interviewed (five MFH program coordinators, two PSAs, and three in-person focus groups with 32 HBPC team members). One interview with a PSA was conducted by telephone. All participants were involved with their respective local MFH programs.

Results:
Five main themes emerged as contributing to MFH program growth, and if absent, thwarted growth. These include: Presence of a dedicated MFH coordinator; Adequate enlistment of HBPC support to the program and coordinator; Leadership support at the facility level; Alignment of right caregiver, right home, and right Veteran; and Receipt of appropriate MFH program referrals.

Implications:
The VHA MFH program offers a more personalized alternative to traditional institutionalized nursing home care for eligible Veterans. The presence of the themes identified here significantly influenced program growth and expansion. In particular, if the relationship is strong between the MFH coordinator and the HBPC team, more appropriate Veteran referrals are generated and in turn ideal matches made between the Veteran, caregiver, and home. However, if MFH coordinators have multiple collateral duties or HBPC teams do not strongly support the program, appropriate referrals are not obtained and potential matches between the right caregiver, home, and Veteran remain unfulfilled. Additionally, support and understanding from facility leadership proved crucial to the growth of the MFHs.

Impacts:
If themes identified by this research are addressed MFH programs will continue to grow to become viable, attainable, and appealing options for long-term care for Veterans who desire more personalized long-term care.