Objectives: To evaluate the associations between specific functional needs of older Veterans and the desire to institutionalize (DTI) among their caregivers. Methods: Cross-sectional multivariable logistic regression analysis of 3579 Hero Care survey responses from caregivers of Veterans at five US sites from July to December 2021. Unmet needs were areas in which the caregiver reported the Veteran needed a little more or a lot more help. Caregiver DTI was defined as the caregiver reporting that they had discussed, considered, or taken steps toward a nursing home or assisted living placement for the Veteran or that they felt the Veteran would be better off in such a setting or they were likely to move the Veteran to another living arrangement.Results: Caregivers were largely white, retired, females with an average age of 71 and with some college education who spent an average of 8-9 h per day 6 days a week caring for a Veteran spouse. There was evidence of associations between the following needs and a DTI: managing incontinence, using the telephone, transportation, and arranging services in the home such as visiting nurses, home care aides, or meals on wheels. Unmet functional needs in other selected domains were not associated with the DTI.Conclusion: Among caregivers of older Veterans, a need for more assistance managing incontinence, telephone use, transportation, and arranging in-home services were associated with the DTI. These may represent functional markers of important clinical determinants for institutionalization as well as potential

Background Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to–Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. Objective The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. Methods We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. Results Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. Conclusions Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans’ needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. International Registered Report Identifier (IRRID) DERR1-10.2196/46156

BACKGROUND High-risk Veterans often have poor ability to maintain health due to complicated unmet health and social needs. The use of Peers is a promising approach to improving patient engagement and addressing unmet needs. OBJECTIVE High-risk Veterans often have poor ability to maintain health due to complicated unmet health and social needs. The use of Peers is a promising approach to improving patient engagement and addressing unmet needs. METHODS The P2P intervention is a clinical demonstration pilot of older HNHR Veterans in one Department of Veterans Health Affairs (VA) hospital. Participants receive i. a peer-led home visit to identify unmet needs and home safety risks aligned with Age-Friendly Health Systems, ii. care coordination, healthcare system navigation and linking to needed services and resources in collaboration with their Patient Aligned Care Team (PACT), and iii. patient empowerment and coaching using VA Whole Health principles. Peers work with Veterans through in-person visits, telephone calls, or via videoconferencing, depending on patient preferences. The primary outcome is change in mean healthcare engagement 6-months pre- to 6-months post- P2P in the intervention group, and compared to a matched control group, as measured by outpatient healthcare utilization and use of home services. Secondary descriptive measures include number and type of unmet needs identified during the home visit, and barriers and facilitators to P2P intervention implementation. RESULTS Study enrollment began in July 2020 and was completed in fall 2022. Pilot study findings are expected to be published in 2023. CONCLUSIONS P2P is the first intervention to examine the effectiveness and feasibility of Peers integrated into PACT conducting a peer-led home-visit for unmet needs identification among older HNHR Veterans, to improve health care engagement and link Veterans to needed services. We also examine factors that could impact P2P’s future implementation in VA settings.