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2023 HSR&D/QUERI National Conference Abstract

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4108 — How Veterans and Caregivers Adapted to Changes in VA Home Based Primary Care Delivery & Increased Social Isolation during the COVID-19 Pandemic

Lead/Presenter: Leah Haverhals,  COIN - Seattle/Denver
All Authors: Haverhals LM (Denver-Seattle Center of Innovation for Veteran-Centered & Value-Driven Care VA Eastern Colorado Health Care System), Manheim, C (Denver-Seattle Center of Innovation for Veteran-Centered & Value-Driven Care VA Eastern Colorado Health Care System) Barnard, J (Denver-Seattle Center of Innovation for Veteran-Centered & Value-Driven Care VA Eastern Colorado Health Care System) Wyte-Lake, T (Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA)

Objectives:
The United States (US) Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) program provides in-home healthcare via interdisciplinary care teams for over 50,000 Veterans across 400 programs nationally. HBPC Veterans are often older, manage chronic health conditions, and experience difficulty accessing traditional outpatient care. The COVID-19 pandemic caused disruptions in routine in-home HBPC delivery and required Veterans and caregivers to socially distance to reduce chances of contracting COVID-19. In this abstract we describe experiences of HBPC Veterans and their caregivers managing changes in care delivery and increased social isolation during the COVID-19 pandemic.

Methods:
From December 2020-April 2021 we conducted N = 38 semi-structured phone interviews with Veterans (average age 78) and caregivers (average age 62) across eight VA HBPC programs. We selected programs from those we studied in previous national HBPC research. Interview data were transcribed verbatim and we applied a team-based analytic approach, using deductive and inductive codes to identify themes.

Results:
Veterans and caregivers shared that video and phone visits increased during the pandemic. However, many stated preferences to return to in-person care when safe and available, as they missed interacting with HBPC staff. In contrast, a few participants felt video visits were more appropriate and effective for certain visits, and hoped they would continue. Participants noted that some VA HBPC staff still provided in-person care during the pandemic, with everyone wearing masks, and, weather-permitting, visits taking place outside. Participants stressed quality of care remained high, describing HBPC staff as dedicated, trustworthy, and adapting quickly to changes brought on by COVID-19. Caregivers described feeling very supported by HBPC staff, especially as they had to provide more hands-on care that HBPC staff and home healthcare providers normally would do. Caregivers also had a harder time managing isolation than Veterans, who were more used to being homebound. Veterans and caregivers relied heavily on social support of their families, neighbors, and friends. Those residing in assisted living facilities shared feeling more isolation and loneliness compared to those living in their own homes. Veterans and caregivers coped during this time through normalizing pandemic-related challenges, looking forward to the pandemic ending, and being creative in activities they participated in, which were often online or application-based to ensure social distancing.

Implications:
Veterans receiving VA HBPC care and their caregivers shared important insights in navigating care delivery changes and social isolation related to COVID-19. They proved open to increased care by video and phone, understanding of the challenges their care providers faced, and appreciative of the dedication of staff and care received. Those with stronger social networks prior to the pandemic drew on them to manage increased isolation, which is important to consider for older, homebound populations during future crises.

Impacts:
Gathering insights from older Veterans who receive primarily in-home care, and their caregivers, is critical to inform how to best support them during and after crises like the COVID-19 pandemic. More research is needed to determine how similar populations manage long-term pandemic-related changes to receipt of in-home care and management of potential continued social isolation.