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2023 HSR&D/QUERI National Conference Abstract

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1091 — Identifying Unmet Needs of High-Need, High-Risk Veterans and their Caregivers Using a Prospective Survey

Lead/Presenter: Stuti Dang
All Authors: Dang S (Miami VAMC, University of Miami Miller School of Medicine, Elizabeth Dole Center of Excellence in Veteran and Caregiver Research), Garcia-Davis S (University of Miami, Miller school of Medicine) Desir M (Miami Veterans Affairs Healthcare System, University of Miami Miller school of Medicine) Munoz R (Florida International University, Robert Stempel College of Public Health & Social Work, Miami, FL) Noel P (South Texas Veterans Health Care System, San Antonio, TX, Elizabeth Dole Center of Excellence in Veteran and Caregiver Research) Hansen J (George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, University of Utah School of Medicine, Salt Lake City, UT) Brintz B (University of Utah, Salt Lake City, UT) Valencia W (Medical University of South Carolina, Summerville, SC) Rupper R (University of Utah, Salt Lake City, UT, Salt Lake City VA Medical Center, Salt Lake City, UT) Bouldin ED (Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, & Department of Internal Medicine, University of Utah, Salt Lake City, Utah, Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research) Trivedi R (Palo Alto VA Medical Center, Palo Alto, CA) Penney LS (South Texas Veterans Health Care System, Research & Department of Medicine, University of Texas Health Science Center at San Antonio, Long School of Medicine, San Antonio, Texas, USA, Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research) Pugh MJ (University of Utah, Salt Lake City, UT, Salt Lake City VA Medical Center, Salt Lake City, UT) Kinosian B (Philadelphia Veterans Affairs Medical Center, Philadelphia, PA) Intrator O (GECDAC (Geriatrics & Extended Care Data & Analysis Center), Canandaigua VA Medical Center, Canandaigua, NY, University of Rochester School of Medicine and Dentistry, Rochester, NY) Leykum L (UT Health Science Center at San Antonio, San Antonio, TX) Elizabeth Dole Center of Excellence in Veteran and Caregiver Research Group

Objectives:
Empowering Veterans to age in place is a VA priority. Informal caregivers play a crucial role supporting Veterans with functional and cognitive impairments through direct provision of care for Veterans as well as arrangement of home and community-based services (HCBS). Delaying long term institutionalization (LTI) depends on identifying and supporting each Veteran’s needs. We aim to understand the unmet needs of older Veterans and the roles of their caregivers, and assess racial/ethnic differences.

Methods:
Hero Care is a longitudinal survey of 20,000 Veterans and their caregivers. We oversampled veterans with a higher predicted two-year risk of LTI. The survey was conducted via mail and electronically. The surveys assessed demographic, physical, psychological, and social domains, unmet needs, and experience with HCBS and caregiver support programs. Veterans from San Antonio, Palo Alto, Miami, Salt Lake City, and Veteran Integrated Service Network 8 living in the community and not on hospice were sampled to reflect LTI risk.

Results:
Forty percent (8,056) Veterans responded to the survey between July-December 2021. Respondents were 80.3 (SD: 9.8) years-old on average, mostly White (82.6%), and men (94.0%). Their 3,579 caregivers were 71.1 (SD: 13.1) years-old on average, mostly White (80.5%), and women (75.1%) who were spousal caregivers (57.1%). Unmet needs were defined as having insufficient help (needing a little or a lot more help). Veterans reported unmet needs in ADLs (15.7%), IADLs (26.0%), nursing tasks (7.9%), pain management (15.1%), communicating with the healthcare team (18.2%), and social needs such as legal or housing (12.1%). The most common IADL unmet needs were medication management (55.4%), housework (55.4%) and preparing meals (53.7 %). Compared to Non-Hispanic Whites, Hispanics and Non-Hispanic Blacks were more likely to have unmet ADL and IADL needs than met needs. Caregivers averaged 7.3 hours of daily care (SD: 5.5 hours); and helped with ADLs (42.5%), IADLs (57.2%), communicating with the healthcare team (52.4%), and social needs (36.4%). Caregiver preparedness when assisting Veterans with tasks varied; 62% of caregivers felt very prepared, 35% somewhat prepared, and 3% not at all prepared to perform tasks. Caregivers reported having a second helper (34%), a third (13%), and a fourth helper (6%) for caregiving tasks. When asked about use of different VA-specific caregiver resources, only 11% of caregivers reported using any programs or resources, while 46.9% had not used them, and 42.1% were not aware of them.

Implications:
Both Veterans and caregivers describe complex unmet needs that include medical, psychological, and social domains. Unmet IADL needs were most common. Racial ethnic differences were identified in the likelihood of having unmet ADL and IADL needs. Barriers to accessing caregiver support programs may include lack of awareness of VA and non-VA programs.

Impacts:
VA may use survey results to inform HCBS policy to support aging Veterans and their caregivers. Identifying unmet needs can inform program development and targeted resource allocation to better meet aging Veterans’ needs. The VA may benefit from investing in advertising available caregiver support programs and developing strategies (e.g., peer navigators) to match Veterans and caregivers in greatest need with appropriate services.