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2023 HSR&D/QUERI National Conference Abstract

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4094 — Supports and challenges in access to Veteran care during the COVID-19 pandemic: a mixed methods study of Veteran caregiver experiences

Lead/Presenter: Lauren Penney,  Elizabeth Dole Center of Excellence for Veteran and Caregiver Research
All Authors: Penney LS (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio), Noel PH (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio) Hernandez-Swift K (South Texas Veterans Health Care System, San Antonio) Trivedi R (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Center for Innovation to Implementation, Palo Alto) Kalvesmaki A (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City) van Houtven C (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham) Dang S (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Miami VA Healthcare System, Miami) Butler J (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City) Pugh MJ (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City) Leykum LK (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio)

Objectives:
The COVID-19 pandemic created conditions that affected informal caregivers’ roles, responsibilities, and well-being. We describe the supportive and challenging ways the VA context of care and responses to the pandemic impacted Veteran caregivers.

Methods:
We conducted a sequential explanatory mixed methods study in five, regionally diverse VA health care systems. Veteran caregivers were eligible to participate if they were at least 18 years old, and their Veteran received care within one of the five systems, needed help with at least one activity of daily living, and required assistance for at least the prior six months. Data were collected from May 2021 to May 2022, through an online or paper-based survey and optional phone interview. Surveys and interviews measured factors that impacted caregiving (including changes to accessing VA care), and changes to caregiver well-being and roles. All interviews were audio recorded and transcribed. We used descriptive methods and content analysis on our survey data, and a rapid, matrix-based approach for our interview data. Findings were triangulated by domain to identify patterns across caregiver experience and where the qualitative data helped to explain quantitative findings.

Results:
Veteran caregivers participated in surveys (n = 54) and follow-up interviews (n = 28). Survey participants had a mean age of 60 (range 32-83); 93% were women, 54% were White, and 76% were a spouse/partner to their Veteran. Caregivers reported impacts from VA-enacted COVID-19 precautions (e.g., services moved to virtual modalities, the closure of some specialty programs and supports, and restrictions on caregiver inclusion during in-person visits and inpatient stays) and the expansion and enhancement within the VA Caregiver Support Program. These changes differently impacted caregivers’ responsibilities, yielding positive benefits (e.g., reduced travel burden, prevention of potential exposure to COVID-19, widened opportunities for caregiver training, emotional, and financial support) and challenges (e.g., delayed diagnosis of Veterans’ new conditions, reduction or elimination of respite care, frustrations related to stipend program eligibility assessment). While some caregivers reported feeling that their caregiver roles were well supported by the VA during the pandemic, others reported feeling cut off from the VA, resulting in greater caregiver responsibilities and burden. Generally, pandemic-related obstacles to VA access eased after the first year, though some caregivers mentioned continued difficulties accessing certain supports, such as respite care.

Implications:
Within the context of the VA health care system and its various resources and processes, Veteran caregivers reported both positive and negative experiences during the first two years of the pandemic. VA COVID precautions and coincidental expansion of the VA Caregiver Support Program were generally described positively by caregivers in our study, but created challenges for some caregiver-Veteran dyads.

Impacts:
Our findings indicate areas in which the VA can improve supports for caregivers as the pandemic continues, including addressing the ongoing need for safe and easy to access respite care, and assistance navigating or accessing the many VA resources and bureaucratic processes (e.g., caregiver stipend).