Veteran-directed care program is effective

A new study led by Boston University School of Public Health (BUSPH) and Veterans Affairs Boston Healthcare System researchers finds that a program that gives veterans flexible budgets for at-home caregivers is at least as effective as other veteran purchased-care services. Published in the June issue of Health Affairs, the study shows that, although the average enrollee in the Veterans Health Administration (VHA)'s Veteran-Directed Care (VDC) program has more complex health burdens than veterans in other purchased-care programs, enrollees in both groups had similar hospitalization and cost trajectories.

VDC provides monthly budgets and counseling to veterans who need significant assistance with daily living, allowing them to hire personal care workers or family and friends as paid caregivers to help them continue living at home. The VDC program launched in 2009, and has proven very popular with veterans and their family caregivers, but is not yet operational nationwide.

"Given the popularity of this program, and our findings that enrollees have similar outcomes as enrollees in other programs, further expansion of Veteran-Directed Care may be justified," says Dr. Melissa Garrido, associate director of the Partnered Evidence-Based Policy Resource Center (PEPReC) at the VA Boston Healthcare System and research associate professor of health law, policy & management at BUSPH.

The researchers used VHA data from fiscal year 2017 to identify 965 VDC enrollees, 21,117 veterans receiving other purchased-care services at VHA medical centers that offered VDC, and 15,325 veterans receiving other purchased-care services at VHA medical centers that did not yet offer VDC but were interested in implementing the program. The researchers then looked at VHA hospitalizations and related costs for all of these veterans in 2016 and in 2018. When the researchers controlled for demographics, levels of care needed, duration of care, the biases of the data, and other factors, they found similar changes in hospitalization rates and costs from before and after enrollment in VDC or another program.