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INV 19-193 – HSR Study

INV 19-193
Building a Model VA-State Partnership to Support Non-Institutional Long-Term Care for Veterans
Robert E. Burke, MD MS
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
Philadelphia, PA
Funding Period: October 2019 - March 2022


The aging Veteran population presents enormous challenges to the VA. There are currently more than 4 million Veterans age 65 and older, and the number of priority 1A Veterans--who are eligible for VA-paid nursing home care--will double to more than 1 million by 2023. Veterans, like most older adults, wish to remain in non-institutional care settings as long as possible. However, nearly two-thirds of the more than $7 billion in annual VA spending on long-term services and supports (LTSS) is consumed by care in nursing homes. States face similar demographic and budget challenges, and are similarly redirecting their spending away from institutional LTSS towards home and community-based services (HCBS). While the incentives of the VA and states are aligned, their efforts are not. VA-based and state-based efforts to enable older adults to age in place are siloed from one another despite the fact that the populations they target substantially overlap. The result is a lack of coordination that prevents most states from answering simple questions, such as “what proportion of Veterans who are at high risk for needing nursing home care are having their needs met through VA and state HCBS?” This lack of coordination represents a tremendous lost opportunity. We propose to address this lost opportunity with an innovation focus—one defined by increasing rates of our primary outcome, days alive and in the community among high-risk Veterans. Establishing best practices for VA-state partnerships to promote community living in high-risk Veterans has the potential to improve quality of life, satisfaction, healthcare utilization, and costs for Veterans. Specifically, during the pilot period, our Specific Aims are to: 1) Establish a process that can be used to establish a shared data infrastructure between the VA, Area Agencies on Aging, states (including Departments of Aging and/or Departments of Military and Veteran Affairs) and managed Medicaid LTSS programs across multiple states. 2) Using an innovation focus, rapidly assess feasibility and acceptability of different models that could help coordinate VA and state supports for high-risk Veterans. 3) Assess barriers and facilitators to dissemination and implementation in other states. 4) Build evidence for a successful Phase II application. Our long-term goals for Phase II are to expand the shared data infrastructure and pilot interventions created in Phase I to other states using an implementation science framework to address barriers and facilitators. Innovation: We propose to address this lost opportunity with an innovation focus—one defined by increasing rates of our primary outcome, days alive and in the community among high-risk Veterans - and largely agnostic to the ways to achieve them. We have ideas for initial solution steps, but we aim to judge ourselves not on the approaches we use, but on our ability to improve these rates. It is that kind of focus that distinguishes us as an innovation program, rather than a more traditional incremental research approach.

External Links for this Project

NIH Reporter

Grant Number: I01HX003011-01

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None at this time.

DRA: Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Health Systems
DRE: Technology Development and Assessment, TRL - Applied/Translational
Keywords: Best Practices, Medication Management, Practice Patterns/Trends
MeSH Terms: None at this time.

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