Abstract
The complex care needs of older adults arising at the intersection of age-related
illnesses, military service, and social barriers have presented challenges to the
US Department of Veterans Affairs (VA) for decades. In response, the VA has invested
in centers that integrate research, education, and clinical innovation, using approaches
aligned with a learning health care system, to create, evaluate, and implement new
care models. This article presents an integrative review of 6 community care models
developed within the VA to manage multimorbidity, complex social needs, and avoid
institutional care, examining how these models address complex care needs among older
adults. The models reviewed include Home Based Primary Care, Medical Foster Home,
the VA Caregiver Support Program, the Resources Enhancing Alzheimer's Caregiver Health
(REACH)-VA program, the Caregivers of Older Adults Cared for at Home (COACH) program,
and Veteran Directed Care. Core components and evaluation outcomes for each model
are summarized, along with implications for more widespread implementation and research.
Each model promotes coordinated care, integrates behavioral health, and leverages
interprofessional expertise. All models are cost-neutral or incur only modest cost
increases to improve outcomes. Broader implementation will require interprofessional
workforce development, payment model realignment, and infrastructure to evaluate outcomes
in new settings. The VA provides a blueprint for infrastructure that could be adapted
to other domestic and international settings. Care models successfully implemented
within the VA's single-payer system hold promise to address persistent dilemmas in
long-term care, such as management of multimorbidity and social drivers of health,
integration and support of family caregivers, and mental health integration. These
models also demonstrate the value of incorporating care approaches that have been
developed or tested outside the United States and argue for greater cross-fertilization
of ideas from different health systems.
Keywords
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Article info
Publication history
Published online: November 09, 2022
Footnotes
The authors declare no conflicts of interest.
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
