Abstract

Significance: Older Veterans who experience homelessness (VEH) often have chronic disease burdens and functional impairments that far exceed their chronological age, persist after housing is obtained, and contribute to frequent hospitalizations and early admission into long-term care facilities. Most Veterans Affairs Supportive Housing (HUD-VASH) lacks the long-term care supports needed to help older VEH age safely in the home. In 2022, the VA Homeless Programs Office (HPO) initiated the HUD-VASH Enhanced Geriatric Service (EGS) program. Select VA facilities received funds to hire and embed interdisciplinary clinical teams in project-based housing (PSH) - multi-unit housing buildings where services and staff are co-located – to support aging VEH. Our research will impact Veteran health by determining whether the HUD-VASH EGS program improves aging-related outcomes in VA's healthcare system (i.e., days in the home, healthcare utilization, costs) and Veteran-centered outcomes (i.e., successful aging, housing satisfaction). Our proposal aligns with VA health system research priorities (NOT-RD-01-HSR: meeting diverse and changing needs of aging populations, addressing social determinants of health), and incorporates the Veteran-focused Quintuple Aim goals and learning health system core competencies (i.e., policy science). Innovation & Impact: This is the first time VA has dedicated specific-purpose funding to provide EGS within PSH, which presents a unique and timely opportunity to study how funds can be used to optimize care for the growing population of older VEH. With elements of a natural experiment, we will leverage national variation in types of PSH (PSH+EGS, PSH-only) to test the effectiveness of EGS on days in the home, healthcare utilization and healthcare costs. We plan to survey VEH using validated survey instruments and open-ended questions to learn what contributes to successful aging for VEH, and develop a toolkit resource for EGS providers and stakeholders. Project findings will help the HPO make data-informed decisions about whether to continue funding for the 18 PSH+EGS sites, whether to expand EGS to other PSH sites across the country, and how to modify service supports to better align with Veteran-centered outcomes, such as successful aging. The findings may also help develop VA as a model for other communities on how to serve their increasingly aging homeless populations. Specific Aims: This study has 3 aims: 1) determine the impact of the HUD-VASH EGS program on days in the home, healthcare utilization and healthcare costs for older VEH residing in PSH; 2) identify aspects of housing and services that support successful aging among older VEH in PSH; and 3) develop a data-informed provider toolkit for EGS in PSH through a multi-step process. Methodology: In Aim 1, we will conduct difference-in-differences analyses to compare PSH models (18 PSH+EGS sites versus 108 PSH-only sites) on numbers of days in the home (i.e., days lived outside of hospitals and long-term care facilities); outpatient, emergency, inpatient and nursing home utilization; and healthcare costs. In Aim 2, we aim to survey 300 older VEH from PSH sites to assess Veteran perceptions of successful aging using validated measures and open-ended qualitative questions. In Aim 3, we conduct semi- structured interviews with EGS clinicians and stakeholders regarding local adaptations, barriers and facilitators to implementation, and suggestions for improvement. Using a modified Delphi approach, we will prioritize qualitative themes and quantitative results from Aim 1-2 to create a toolkit for PSH providers and stakeholders. Path to Translation/Implementation: Our study will be conducted in close partnership with HPO and HUD-VASH. We will use findings from this research to develop a toolkit to assist PSH sites with EGS implementation that can also inform HPO's strategic planning to support aging Veterans. Future research will test implementation strategies to improve uptake in a wider array of facilities and determine cost-effectiveness.

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DRA: Aging, Older Veterans' Health and Care, Health Systems Science

DRE: Treatment - Comparative Effectiveness, Engagement Science

Keywords: None at this time.

MeSH Terms: None at this time.