Developing an Intervention to Enhance Aging in Place for Older Veterans Living in Permanent Supportive Housing

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 aged ≥50. Few interventions have been developed to address the needs of older Veterans in HUD-VASH.

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 9 staff and 1 Veteran to prioritize 66 intervention elements based on perceived feasibility and importance.

We identified 4 main themes: need for services to support aging in place, expanding the HUD-VASH workforce, focus on home delivery, and 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).

Veterans and staff members identified key intervention elements which can help inform Veterans Affairs (VA) efforts to develop and implement interventions to enhance aging in place in HUD-VASH.