# Maximizing the Value of VA Homemaker/Home Health Aide (H/HHA) Services to Veterans, Caregivers and VA: Supporting Older Veterans’ Pathways to Stable H/HHA Care

> **NIH VA IK2** · JAMES J PETERS VA  MEDICAL CENTER · 2024 · —

## Abstract

Background: Home health aides (HHAs) advance VA’s priority to honor Veterans’ desire to age in place by
improving health outcomes, reducing family caregiver burden and strain, and delaying or avoiding costly
institutional placement. Lack of adequate, stable HHA support for older Veterans is associated with loneliness,
depression and mortality. Improving access to HHA services is an urgent VA and legislative priority, and VA’s
HHA benefit is the health system’s most widely used and fastest growing home and community-based service
(HCBS). But because HHA care is purchased from community providers, navigating care can be complex and
fragmented. Ensuring stable, continuous HHA care thus demands a stakeholder-engaged systems approach to
better understand how Veterans navigate roadblocks and to identify potential interventions at the individual,
organizational and policy levels. My extensive research and professional experience with HHAs and my
qualitative training prepares me for this work. With mentorship and additional training in process improvement,
intervention development, implementation science, and trial design, I will leverage this CDA’s findings into a
bundle of actionable, multi-level interventions and advance my VA career.
Specific Aims: This proposed CDA simultaneously fills the gaps in my training and provides VA with rigorous
research on which to ground future interventions to strengthen Veterans’ caregiving teams in the home. This
work is guided by a theory-driven framework and supported by operational partners in GEC, Caregiver
Support, and Primary Care. Aims will: (1) Systematically describe the process of receiving and maintaining VA-
paid HHA services by identifying steps; individual, organizational and policy-level roadblocks; and promising
points of intervention. (2) Collaboratively adapt VA’s established Caregivers FIRST family caregiver curriculum
for VA-paid HHAs. (3) Conduct a pilot and formative evaluation of the intervention at the Bronx VA.
Methods: Aim 1: At 4 VAMCs diverse in geography, size, and HHA benefit structure, I will create process
maps using participatory methods with Veterans, caregivers, VA primary care teams, VA HCBS coordinators,
home health agencies and HHAs to prioritize potentially modifiable organizational factors to improve HHA
access. Aim 2: Through a stakeholder-engaged co-design process informed by previous pilot data and the
needs and barriers identified in Aim 1, I will develop an intervention to better prepare HHAs to provide Veteran-
centered care. Aim 3: I will use mixed methods to assess implementation outcomes (feasibility, acceptability,
usefulness) and HHA outcomes (preparedness). I will also examine potential downstream measures (caregiver
burden, Veteran days at home).
Expected Results and Next Steps: Throughout this study, I will provide my operational partners with key
deliverables, including HHA process maps and priorities for organizational-level interventions, and a scalable,
stakeho...

## Key facts

- **NIH application ID:** 10880233
- **Project number:** 5IK2HX003334-02
- **Recipient organization:** JAMES J PETERS VA  MEDICAL CENTER
- **Principal Investigator:** Emily C. Franzosa
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-07-01 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10880233

## Citation

> US National Institutes of Health, RePORTER application 10880233, Maximizing the Value of VA Homemaker/Home Health Aide (H/HHA) Services to Veterans, Caregivers and VA: Supporting Older Veterans’ Pathways to Stable H/HHA Care (5IK2HX003334-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10880233. Licensed CC0.

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