The elderly population in America is growing. For the first time in U.S. history, adults over the age of 65 are on pace to outnumber children under 18 by 2034. With this demographic shift comes a greater demand for health services and a need to innovate care delivery systems in order to meet those demands.
As the largest integrated healthcare system in the U.S., VA serves a veteran community that trends older and less healthy than the general population. The department has implemented innovations to meet the health and related social needs of older veterans, putting us ahead of the curve and making us a leader in geriatric and extended care. These approaches could offer solutions for the overarching American healthcare system as baby boomers age.
Some of our top efforts focus on helping veterans age at home. Research shows that aging at home has physical, psychological and social benefits. These include reduced mortality rates, increased physical functioning, and decreased symptoms of depression.
VA’s home and community-based programs offer support to veterans who need help with activities of daily living to maintain their independence. Our Home Based Primary Care model provides comprehensive interdisciplinary health care services to veterans in their homes. Through this model, a VA physician supervises a team who provide veterans complex healthcare needs. Another model, the Veteran Directed Care program, allows veterans who need assisted living to hire caregivers and purchase goods and services to meet their personal care needs from a list of providers curated and trained by HHS.
In addition to providing care for veterans, VA provides support for caregivers through our Program of Comprehensive Assistance for Family Caregivers. Veterans who qualify can apply for financial support and some medical care for their caregivers. Primary caregivers may receive a monthly stipend, access to health insurance, mental health counseling, certain travel benefits, and respite care. Due to the success of the program, VA expanded eligibility to more veterans and their caretakers.
When options for living at home are exhausted, VA meets veterans’ needs with over 130 Community Living Centers (CLCs), analogous to nursing homes. CLCs are designed to resemble “home,” with activities for veterans of all ages and family-friendly places for visiting. Veterans decorate their rooms, and pets visit or live in the CLC. Veterans who need 24-hour care can also participate in the Medical Foster Home program where caregivers welcome them into their homes and provide care and supervision. VA inspects and approves all medical foster homes, connects veterans to a home-based primary-care team and trains caregivers. Thus, whether a veteran’s stay is at a CLC or medical foster home, they are afforded the health benefits of community and VA guided treatment.
VA long-term care facilities also lead the way in patient safety. While nursing homes in the private sector experienced more than one-third of American COVID-19 fatalities, VA took early steps to contain outbreaks, initiating changes that could be modeled nationwide. VA’s restrictions in CLCs limited exposure and potential introduction of the virus. VA also managed and continues to manage personal protective equipment, virus testing and vaccinations on a system level, ensuring adequate supplies. Finally, VA leveraged a common electronic health record to identify, advise and assist CLCs with multiple cases.
VA’s work to improve elder care continues. Our Geriatric Research, Education and Clinical Center builds knowledge in geriatric care through research, develop innovative clinical models of care, and provide training and education on best practices for students in healthcare disciplines. VA’s Geriatrics and Extended Care Data Analysis Center advances elder care by collecting and analyzing data related to aging and frail veterans, allowing VA to make informed decisions on how to continue to offer high-quality programs and services.
VA’s experience and expertise can serve as a broader example for the general population. Its models for elder care, support for caregivers and continued research have demonstrated the improved health outcomes and fiscal savings necessary to combat the surge in demand on the American healthcare system now and in the future.