Developing an intervention to enhance aging in place for older veterans living in permanent supportive housing

BACKGROUND AND OBJECTIVES: The Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program provides rental subsidies, case management, and supportive services to Veterans who are currently or formerly homeless, 77% of whom are ages ≥50. Few interventions have been developed to address the needs of older Veterans in HUD-VASH. 

RESEARCH DESIGN AND METHODS: We conducted a 2-stage study to inform the development of an intervention to promote aging in place in HUD-VASH. First, we completed qualitative interviews with 21 older Veterans in HUD-VASH and focus groups with 13 staff members to identify unmet needs for supporting aging in place. Second, we used a modified Delphi process with nine staff and one Veteran to prioritize 66 intervention elements based on perceived feasibility and importance. 

RESULTS: We identified four main themes: need for services to support aging in place; expanding the HUD-VASH workforce; focus on home delivery; importance of trust. The top-rated intervention elements spanned 5 categories: (1) staffing (by social workers, primary care providers, nurses, home health aides); (2) focus (on geriatric needs, mental health needs, dementia care, medication management); (3) modality (in the home or medical center); (4) timing (delivery of the intervention when Veterans have functional impairment, memory impairment, mental health problems, trouble caring for themselves, or are new to HUD-VASH); and (5) duration (regularly scheduled or ongoing as needed). 

DISCUSSION AND IMPLICATIONS: Veterans and staff members identified key intervention elements which can help inform VA efforts to develop and implement interventions to enhance aging in place in HUD-VASH.