Developing an Intervention to Enhance Aging in Place for Older Veterans Living in Permanent Supportive Housing.

Background and objectives: The Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program provides rental subsidies, case management, and supportive services to Veterans who are currently or formerly homeless, 77% of whom are aged ≥50. Few interventions have been developed to address the needs of older Veterans in HUD-VASH.

Research design and methods: We conducted a 2-stage study to inform the development of an intervention to promote aging in place in HUD-VASH. First, we completed qualitative interviews with 21 older Veterans in HUD-VASH and focus groups with 13 staff members to identify unmet needs for supporting aging in place. Second, we used a modified Delphi process with 9 staff and 1 Veteran to prioritize 66 intervention elements based on perceived feasibility and importance.

Results: We identified 4 main themes: need for services to support aging in place, expanding the HUD-VASH workforce, focus on home delivery, and importance of trust. The top-rated intervention elements spanned 5 categories: (1) staffing (by social workers, primary care providers, nurses, home health aides); (2) focus (on geriatric needs, mental health needs, dementia care, medication management); (3) modality (in the home or medical center); (4) timing (delivery of the intervention when Veterans have functional impairment, memory impairment, mental health problems, trouble caring for themselves, or are new to HUD-VASH); and (5) duration (regularly scheduled or ongoing as needed).

Discussion and implications: Veterans and staff members identified key intervention elements which can help inform Veterans Affairs (VA) efforts to develop and implement interventions to enhance aging in place in HUD-VASH.