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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4007 — A Qualitative Exploration of Veteran and Family Perspectives on Medical Foster Homes

Lead/Presenter: Cari Levy, COIN - Seattle/Denver
All Authors: Gilman CV (COIN - Seattle/Denver) Haverhals LM (COIN - Seattle/Denver) Manheim CE (COIN - Seattle/Denver) Levy CR (COIN - Seattle/Denver)

As the aging and disabled Veteran population rapidly grows, a shift to home-based long-term care services has begun to adequately meet their needs. Since 2008, the Veterans Health Administration (VHA) Medical Foster Home (MFH) program has served as an alternative to nursing home care for Veterans and been proven by previous research to be safe and less costly than nursing home care. This research aimed to describe and explain perspectives of Veterans and their families as to why they chose to select a MFH as their long-term care residence and, conversely, why they declined placement in a MFH.

Fifty-five semi-structured, in-person individual and small-group interviews were conducted with 62 Veterans and/or their families at six different VHA medical centers. As part of a larger national MFH research study, sites were selected based on whether they were fast-growing (the three largest MFH programs at the time of the study) or slower to get off the ground (in existence for at least two years with fewer than 10 veterans enrolled). A team-based, inductive approach was utilized to analyze the interviews. All interviews were transcribed verbatim and analyzed using Atlas.ti qualitative software.

Key themes identified included that highly-individualized care oversight and family-oriented nature of MFHs were noted by Veterans and families as the primary reason for selecting MFHs when considering long-term care options. Veterans and their families had varied reasons for declining placement, which included costs, location of the MFH, lack of readiness, and level of confidence that care needs would be met.

The ability of MFHs to meet nursing home level care needs of Veterans while providing close monitoring in a home-like setting was critical to why Veterans and families chose this long-term care option and, in most cases, continued to be satisfied with this setting.

This research helps expand the knowledge of a non-institutional long-term care alternative for Veterans. It provides important information for both VHA and community clinicians who might recommend long-term care alternatives to Veterans and their families. Lastly, VHA leadership can utilize insights gained from these Veterans and families when strategizing how to expand MFH programs.