Anticipated Impacts on Veteran's Healthcare: Designing and implementing a training program for informal caregivers of functionally impaired Veterans, HI-FIVES will improve the skill of caregivers, thereby improving Veteran health care quality, the ability for Veterans to remain at home, and satisfaction with VHA care. Project Background: Strain, burden and burnout are highly prevalent in caregivers, and are often associated with caregiver depression or increased risk of institutionalization of the care recipient. We propose to evaluate an innovative program that trains informal caregivers when Veterans are referred to VHA home and community-based care (HCBC), a critical moment in a Veteran's VHA health care use. Referral to HCBC is a time that caregivers may face personal strain and uncertainty about demands involved in caregiving. As such, it presents a teachable moment to train caregivers to better meet the demands imposed by caregiving. Project Objectives: To evaluate whether over 12 months, Veterans with caregivers in the skill training program have clinically significant increases in days spent at home compared to Veterans in usual care (e.g., days not in emergency department, hospital, or nursing home);significantly lower VA costs of medical care, and higher satisfaction with VHA. Finally, we will evaluate whether caregivers in HI-FIVES have clinically significant reductions in depressive symptoms post-intervention compared to caregivers in usual care. Project Methods: The study is a randomized controlled trial with data collection from caregiver-patient dyads before and after training, and at 12 months after program completion. The setting is the Durham VAMC. Patient inclusion criteria are patient referred to HCBC in the past 3 months, not eligible for hospice, residing at home, has an informal caregiver, willing to participate and willig to let us contact the caregiver. Caregivers must be adults, capable to participate, understand English, not be treated for a substance abuse disorder, not be in another interventional study, and willing to participate. Caregivers in the control group will receive the training and support usually provided by HCBC. Veterans will have a minimum of 2 activities of daily living limitations, and are likely to have multimorbidity, including high rates of cognitive impairment. The target sample size will be 103 caregiver-dyads in each arm. Patient involvement will be limited to four short phone assessments. Caregivers in the treatment arm will take part in three phone training calls and four group sessions, and in both arms caregivers will be asked to provide four phone assessments. Descriptive statistics will be used to summarize all study variables. Of primary importance will be to examine the distribution of patient days not at home during the 12 months of the post-intervention period. We will use the count-data regression model which best fits our data (Poisson, Negative Binomial or zero-inflated versions of these) to test the primary hypothesis that Veterans with caregivers in HI-FIVES will have significantly more days at home than Veterans in usual care.
The purpose of this study is to evaluate a caregiver skill training program (HI-FIVES), offered as a part of a randomized control trial to caregivers of Veterans referred to home and community-based long-term care. Of primary interest is to examine whether participating in HI-FIVES leads to clinically significant increases in days spent at home for Veterans compared to caregivers in usual care. We aim, through the training, to decrease the number of days over 12 months post-intervention that Veterans spend in the emergency department, hospital, or nursing home. Days spent in these settings reduces the Veteran's quality of life and increases health care costs to the VA. We also will evaluate whether caregivers in HI-FIVES have clinically significant reductions in depressive symptoms post-intervention compared to caregivers in usual care.