Barriers to accessing home and community-based services among family caregivers of Veterans

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-09-25 DOI:10.1111/jgs.19051

Ranak Trivedi PhD, Victoria Ngo PhD, Trevor Lee BS, Marika Blair Humber PhD, Rashmi Risbud MA, Josephine C. Jacobs PhD, Karl Lorenz MD, MSHS, Steven M. Asch MD, MPH, Dolores Gallagher-Thompson PhD, Luci K. Leykum MD, MBA, MSc, the Elizabeth Dole Center of Excellence for Veteran and Caregiver Research

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Abstract

Background

The Department of Veterans Affairs (VA) has long recognized the importance of having a rich complement of home and community-based resources for the Veteran population. For Veterans experiencing disability-related impairments, home- and community-based services (HCBS) facilitate aging in place and alleviate family caregivers' burden. However, even in the enriched VA context, HCBS are underutilized. Our objective was to understand unmet needs and barriers to accessing HCBS from the perspectives of Veterans' family caregivers.

Methods

This multi-method study recruited family caregivers of Veterans seen within a major VA Health Care System. Eligible caregivers provided care for at least 8 h/week in the prior 6 months, to a Veteran with 1+ impairments in instrumental activities of daily living. Recruitment was conducted via flyers, physician referrals, registries, and chart reviews. Participants completed 1-h semi-structured interviews to assess unmet psychosocial needs and barriers to accessing VA and non-VA HCBS. Interviews were analyzed using a thematic analysis approach.

Results

A total of 23 caregivers (62.9 + 13.5 years; 74% women; 52.2% White; 26.1% Black; 95.2% pre-9/11) provided 8.4 ± 6.3 h of daily care. Most had provided care for more than 1 year; nine had cared for their Veteran for 5+ years. The following themes were identified: (1) need for clear, accurate, timely information about HCBS; (2) lack of time, amplified by COVID-19 restrictions; (3) need for respite to manage their own health and other caregiving responsibilities; and (4) perceived difference in care needs that can strain caregivers' relationship with the care recipient.

Conclusions

In addition to known barriers including lack of timely knowledge, service delays, and caregiver stress, Veteran–caregiver disagreements emerged as a novel barrier to using HCBS. A multi-pronged approach that addresses these barriers may increase timely access to HCBS.

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退伍军人家庭照顾者获得家庭和社区服务的障碍。

背景：退伍军人事务部（VA）早已认识到为退伍军人提供丰富的家庭和社区资源的重要性。对于有残疾相关损伤的退伍军人来说，家庭和社区服务（HCBS）有助于居家养老，减轻家庭照顾者的负担。然而，即使在退伍军人事务部的丰富环境中，家庭和社区服务也未得到充分利用。我们的目标是从退伍军人家庭照护者的角度来了解未得到满足的需求和获得 HCBS 的障碍：这项多方法研究招募了在退伍军人医疗保健系统内就诊的退伍军人的家庭护理人员。符合条件的照顾者在过去 6 个月中每周至少为一名在日常生活工具性活动方面有 1+ 缺陷的退伍军人提供 8 小时的照顾。招募通过传单、医生转介、登记和病历审查等方式进行。参与者完成了 1 小时的半结构式访谈，以评估未满足的社会心理需求以及获得退伍军人和非退伍军人 HCBS 的障碍。访谈采用主题分析法进行分析：共有 23 名护理人员（62.9 + 13.5 岁；74% 为女性；52.2% 为白人；26.1% 为黑人；95.2% 在 9/11 事件之前）提供了 8.4 ± 6.3 小时的日常护理。大多数人提供护理的时间超过 1 年；9 人护理退伍军人的时间超过 5 年。确定了以下主题：(1) 需要清晰、准确、及时的 HCBS 信息；(2) 缺乏时间，COVID-19 的限制更加剧了这一点；(3) 需要喘息的时间来管理自己的健康和其他护理责任；(4) 认为护理需求的差异会使护理者与接受护理者的关系紧张：除了已知的障碍（包括缺乏及时了解、服务延迟和护理者压力）外，退伍军人与护理者之间的分歧也成为使用 HCBS 的新障碍。采取多管齐下的方法来解决这些障碍可能会增加及时使用 HCBS 的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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