Expanding Home- and Community-Based Service Access in the Veterans Health Administration

The US Department of Veterans Affairs (VA) offers a continuum of home- and community-based services (HCBS) to support veterans' ability to remain in their homes and communities as they age. Although VA delivers some HCBS directly, many HCBS are provided through contracted agencies in the community. We sought to understand the strategies VA staff use to facilitate veterans' HCBS access, particularly as these services become increasingly difficult to access in many areas.

Qualitative descriptive study using semistructured interviews.

A purposeful sample of VA staff centrally involved in overseeing or coordinating HCBS at facilities that varied geographically and in HCBS use.

Semistructured individual and small group interviews conducted remotely in 2024. Interviews were recorded, transcribed, and analyzed to interpret data and draw out thematic categories related to facilitating veterans' HCBS access.

Seventeen interviews were completed with 34 staff at 11 VA health care facilities. We found extensive variation across facilities in how HCBS programs were organized and coordinated. Common access challenges included limited service availability in certain areas; identifying services to meet special needs (eg, dementia); inadequacy of existing programs for nonmedical support needs (eg, transportation); and coordination-related barriers. We identified 3 overarching themes related to facilitators and strategies to address HCBS barriers. These included (1) education and outreach related to HCBS, (2) collaborative relationships with internal and external partners, and (3) sufficient and stable staffing to coordinate HCBS. Specific activities, strategies, and perspectives related to each of these themes varied across sites.

Although HCBS availability varies across sites and regions, veterans' access also depends on VA staff time to conduct outreach, foster collaborations, and coordinate HCBS with internal and external partners. Understanding and disseminating effective strategies to strengthen veterans' HCBS access is vital as the need for HCBS continues to grow nationally.