# Evaluation of Veteran-Directed Home and Community Based Services

> **NIH VA I01** · PROVIDENCE VA  MEDICAL CENTER · 2020 · —

## Abstract

In the next decade, there will be a doubling of older Veterans for whom the VA has a requirement to provide
long-term care. At a cost of $110,000 per year for long-term care, Geriatrics and Extended Care (GEC) is
seeking to preserve Veteran independence in the community. VD-HCBS is a person-centered consumer-
directed program that provides Veterans the opportunity to self-direct their long-term services and supports
(LTSS) and continue to live independently at home. GEC is planning to expand VD-HCBS to an additional 90
VAMCs over the next 3 years and has partnered with the Program Evidenced-based Policy Resource Center
(PEPReC) for a randomized, stepped-wedge dissemination and an evaluation of utilization outcomes. This
proposal will provide important outcomes and context to the VD-HCBS expansion. The specific aims of this
proposal are: Aim 1: To describe the impact of VD-HCBS on Veterans’ satisfaction, unmet need for services,
quality of life and independence using mixed methods. Aim 1 will utilize operations data to describe the change
in Veteran-reported satisfaction, unmet needs, and independence from enrollment in VD-HCBS to 3 and 12
months. Additionally, we will conduct interviews with Veterans to capture their experiences with the program.
Aim 2: To understand the effect of VD-HCBS on Caregivers’ well-being. Aim 2 will compare Caregivers’
financial strain, depressive symptoms, caregiving stress, and health status and positive caregiver experiences
to a propensity matched population from existing VA data to determine the impact of the VD-HCBS program on
Caregivers. Aim 3: To examine the implementation of the VD-HCBS program expansion. Aim 3 will utilize the
Consolidated Framework for Implementation Research and Expert Recommendations for Implementing
Change to interview coordinators, and other key informants, from VA and ADNA VD-HCBS pairs. The analysis
will shed light on how contextual factors and implementation strategies relate to implementation and Veteran
outcomes. VD-HCBS has tremendous opportunity to improve the fiscal outlook of GEC’s LTSS while delivering
the highest level of Veteran-centered care. In concert with the outcomes of VD-HCBS, our implementation
evaluation will be critical to determining how the VA system, in partnership with community-based
organizations, implements programs and illuminating important leverage points to facilitate implementation
effectiveness. With the diverse team assembled and the comprehensive evaluation proposed, we will produce
evidence to inform VA program implementation and dissemination, a critical component of the VA’s priorities to
develop high-performing, highly-reliable, and consistent networks.

## Key facts

- **NIH application ID:** 9937523
- **Project number:** 5I01HX002376-03
- **Recipient organization:** PROVIDENCE VA  MEDICAL CENTER
- **Principal Investigator:** JAMES L RUDOLPH
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-04-01 → 2020-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9937523

## Citation

> US National Institutes of Health, RePORTER application 9937523, Evaluation of Veteran-Directed Home and Community Based Services (5I01HX002376-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9937523. Licensed CC0.

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