Using Community Health Workers to Support Rural Care Partners of Seriously Ill Older Veterans

About This Grant

Background: How can we apply the community health worker (CHW) model to help both care partners and Veterans with serious illness in rural areas? Little is known about this approach. We will test a VA-supported intervention successfully piloted in the Durham VA and surrounding rural communities in 2021. VA’s Office of Rural Health, Caregiver Support Program and National Social Work Office are aware and support this work. Significance: Clinically, this work will help improve care for rural Veterans with serious illness by supporting care partners in their caregiving role in the community thus bolstering the care of Veterans receiving primary support from care partners in rural areas. A strength of our intervention is that it adapts and extends a successful model of individualized support commonly used outside of the VA. This approach maximizes the potential for sustainability, broad dissemination, and care delivery impact across the VA. This work will be generalizable. Strategically, this SDR proposal responds to the National Academies report recommending all health systems, including VA, develop processes to routinely identify, assess, and support needs of care partners. Our project meets rural health access, long-term care/aging, engagement science, and caregiving HSR priorities for investigator-initiated research focused on rural populations. Additionally, our proposed efforts fit squarely with the VA’s Rural Health State of the Art conclusion that we must expand VA partnerships in the community and help Veterans and their families understand their options for care and support in the community and at the VA. Innovation & Impact: This project is innovative because of its focus on social and practical needs of care partners, advances the science of community engagement in VA care and support, and situates a care partner- focused community health worker model squarely in the VA system for the first time. The entire project is guided by a Community Advisory Board (CAB) composed of social service, serious illness care, and rural care experts plus Veterans and care partners with lived experience. Specific Aims: Aim 1. Determine CHW effectiveness in reducing care partner burden, increasing Veterans' well-being, and increasing care partner-Veteran satisfaction with VA care in the intervention group compared with the usual care (CSP) group: We will apply our feasible CHW intervention to a larger sample, randomized control trial. (Hl) Care partners randomized to the intervention group will have lower mean Zarit-12 scores at 6 months compared to the control group. (H2) Care partners and Veterans randomized to the intervention group will have higher mean 1-item CAHPS Global Satisfaction scores at 6 months compared to the control group. (H3) Veterans randomized to the intervention group will have higher mean Warwick Edinburgh Mental Well- Being scores at 6 months compared to the control group. Aim 2: Following intervention, explore Veterans' and care partners' experience of care and support using subgroup semi-structured interviews in the intervention group. We then facilitate CAB Delphi Method sessions (including study Veterans, CHWs, and care partners) exploring Aims 1/2 data using equity-focused intervention mapping for wider implementation. Aim 3: Conduct budget impact analysis from the VA perspective to evaluate cost-drivers and assess feasibility to inform adaptation and implementation of the intervention within Durham VA Health Care System. Methodology: Two-arm randomized control trial using validated measures. We follow this using qualitative exploration with participants plus a Delphi method exploring implementation with the community advisory board and participants. We end with a unique business impact analysis of the intervention. Next Steps/Implementation: We are supported/advised by VA’s Office of Rural Health and Caregiver Support Program in Durham, NC with additional advisement from National Social Work Office, Chaplaincy, Palliative Care, county Veteran Services and Area Agencies on Aging (see LOS). If successful, this intervention can be added to the options available from CSP to support rural care partners and their seriously ill Veterans.