# Evaluating the Impact of Medical Foster Home Coordinator Effort and Experience on Costs

> **NIH VA I01** · VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF · 2024 · —

## Abstract

This project will address the HSR&D Long-Term Care and Aging priority by investigating Medical Foster
Homes (MFHs) as a community-based long-term care (LTC) alternative, and in particular compared to
Community Nursing Home (CNH) care, the primary program serving LTC needs in institutions. MFH care is
provided in private residences with trained and licensed caregivers, who live on the premises, that serve up to
three Veterans who receive VA Home Based Primary Care (HBPC) services. The need for 24 hour per day
care is increasing as the Veteran population ages. The GAO has projected that, by the year 2037, Veterans’
use of CNHs will increase 80%, and corresponding expenditures will increase approximately 150%, from a
2017 benchmark. Medical Foster Homes care is potentially less expensive for the VA. However, as the VA
considers expanding coverage of direct room & board cost of the MFH to more Veterans, the cost advantage is
unclear and understanding the implications of the MFH environment on Veteran cost and utilization becomes
more important. Across the VA, MFH programs vary in the effort and experience of the coordinators that
manage them. Although there is evidence that MFH programs cost less than CNH in the past, current
estimates are lacking, and the extent to which such cost savings is related to MFH program coordinator effort
and experience has not been established, nor is it understood whether saving is facilitated by VA patient safety
culture. To provide a cost saving alternative to institutional care, it is important to understand coordinator
impact on efficiency of operations. This project will determine the impact of dedicated coordinator effort and
experience, on overall MFH Veteran direct healthcare costs. Additionally, to be a high reliability organization,
the VA emphasizes the development of a patient safety culture among its facilities. This project will determine
whether a patient safety culture moderates the impact of coordinators on program efficiency and will inform
decisions regarding program coordinator coverage and training as impacted by patient safety culture.
 Research on MFHs (see HSR&D CRE 12-029, PI Cari Levy, and subsequent publications) have shown
that VA costs and were lower among Veterans after MFH and costs were lower than Community Nursing
Homes using FY2011 data. Moreover, qualitative work has explored the role of more experienced programs.
However, there has not been quantitative research explicitly on MFH program coordinator effort and
experience in relation to cost or utilization. This project will address this gap. This project includes, in addition
to standard evaluation of expected outcomes, the evaluation of reliability of outcomes, which is expected to
improve with dedicated coordinator effort and experience guided by goals established by a patient safety
culture. The project is therefore also methodologically innovative, as it will evaluate the scale function
(representing the mean-independent variation...

## Key facts

- **NIH application ID:** 10862041
- **Project number:** 1I01HX003809-01A1
- **Recipient organization:** VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF
- **Principal Investigator:** ORNA INTRATOR
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-07-01 → 2027-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10862041

## Citation

> US National Institutes of Health, RePORTER application 10862041, Evaluating the Impact of Medical Foster Home Coordinator Effort and Experience on Costs (1I01HX003809-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10862041. Licensed CC0.

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