Shepherd-Banigan Megan, Smith Valerie A, Stechuchak Karen M, Miller Katherine E M, Hastings Susan Nicole, Wieland Gilbert Darryl, Olsen Maren K, Kabat Margaret, Henius Jennifer, Campbell-Kotler Margaret, Van Houtven Courtney Harold
1 Durham VA Medical Center, NC, USA.
2 Duke University, Durham, NC, USA.
Inquiry. 2018 Jan-Dec;55:46958018762914. doi: 10.1177/0046958018762914.
Family caregivers are an important component of the long-term services and supports (LTSS) system. However, caregiving may have negative consequences for caregiver physical and emotional health. Connecting caregivers to formal short-term home- and community-based services (HCBS), through information resources and referrals, might alleviate family caregiver burden and delay nursing home entry for the patient. The aim of this study was to evaluate the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) (established by P.L. 111-163 for family caregivers of seriously injured post-9/11 Veterans) on Veteran use of LTSS. A two-cohort pre-post design with a nonequivalent comparison group (treated n = 15 650; comparison n = 8339) was used to (1) examine the association between caregiver enrollment in PCAFC and any VA-purchased or VA-provided LTSS use among Veterans and (2) describe program-related trends in HCBS and institutional LTSS use. The comparison group was an inverse-propensity-score weighted sample of Veterans whose caregivers applied for, but were not accepted into, the program. From baseline through 24 months post application, use of any LTSS ranged from 13.1% to 17.8% for Veterans whose caregivers were enrolled in PCAFC versus from 3.8% to 5.3% for Veterans in the comparison group. Participation in PCAFC was associated with a statistically significant increased use of any LTSS from 1 to 24 months post application (over time odds ratios ranged from 2.71 [95% confidence interval: 2.31-3.17] to 4.86 [3.93-6.02]). Support for family caregivers may enhance utilization of LTSS for Veterans with physical, emotional, and/or cognitive conditions.
家庭照护者是长期服务与支持（LTSS）系统的重要组成部分。然而，照护工作可能会对照护者的身心健康产生负面影响。通过信息资源和转介服务，将照护者与正规的短期居家和社区服务（HCBS）相联系，可能会减轻家庭照护者的负担，并延缓患者进入养老院的时间。本研究的目的是评估家庭照护者综合援助计划（PCAFC）（由第111-163号公法为9·11事件后重伤退伍军人的家庭照护者设立）对退伍军人使用LTSS的早期影响。采用具有非等效对照组的双队列前后设计（治疗组n = 15650；对照组n = 8339）来：（1）研究照护者参加PCAFC与退伍军人使用任何由退伍军人事务部（VA）购买或提供的LTSS之间的关联；（2）描述与该计划相关的HCBS和机构LTSS使用趋势。对照组是照护者申请但未被该计划录取的退伍军人的逆倾向得分加权样本。从基线到申请后24个月，照护者参加PCAFC的退伍军人使用任何LTSS的比例在13.1%至17.8%之间，而对照组退伍军人的这一比例在3.8%至5.3%之间。参加PCAFC与申请后1至24个月使用任何LTSS的显著增加相关（随时间变化的优势比范围从2.71[95%置信区间：2.31 - 3.17]到4.86[3.93 - 6.02]）。对家庭照护者的支持可能会提高身体、情感和/或认知状况不佳的退伍军人对LTSS的利用率。
