Miller Katherine E M, Price Megan, O'Malley Katherine, Song Sooyeon, Garrido Melissa M
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Roger and Flo Lipitz Center to Advance Policy in Aging and Disability, Johns Hopkins University, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2025 Jun;73(6):1884-1894. doi: 10.1111/jgs.19492. Epub 2025 May 9.
The Veteran population is aging rapidly, with already higher rates of disability compared to non-Veteran peers. Consequently, demand for home- and community-based long-term services and supports (HCBS) is increasing. Understanding who needs and uses HCBS is particularly important in the Veterans Health Administration (VHA)-a payer for HCBS. Our objective is to describe the characteristics of Veterans who use HCBS, how Veterans who use HCBS differ from those who do not use HCBS, and how Veterans who use different types of HCBS differ from each other.
We use administrative data for VHA-provided and VHA-purchased care for 2021-2023 in a cohort of Veterans aged 65+. We describe Veteran HCBS users versus nonusers, services used, and the association of Veteran demographic characteristics, health status, and prior health care use on the probability of receiving HCBS using generalized estimating equations with binomial family, logit link, and exchangeable correlation structure.
One in 10 older Veterans uses at least one HCBS service, and this share is growing over time. Veterans use home health care and homemaker/home health aide services the most. Most Veterans receive one service. We find that Veterans who are female, Black, or diagnosed with dementia are more likely to use HCBS, while Veterans residing in rural areas are less likely.
Like the challenges facing the aging civilian population, the VHA faces the test of meeting the growing demand for HCBS. Understanding these dynamics is essential to ensuring that HCBS is both accessible and effective in supporting Veterans.
退伍军人人口正在迅速老龄化，与非退伍军人同龄人相比，其残疾率本就更高。因此，对基于家庭和社区的长期服务与支持（HCBS）的需求正在增加。在退伍军人健康管理局（VHA，HCBS的支付方）中，了解谁需要并使用HCBS尤为重要。我们的目标是描述使用HCBS的退伍军人的特征、使用HCBS的退伍军人与未使用HCBS的退伍军人有何不同，以及使用不同类型HCBS的退伍军人之间有何差异。
我们使用了2021 - 2023年为65岁及以上退伍军人队列提供的VHA护理和VHA购买的护理的行政数据。我们描述了退伍军人HCBS使用者与非使用者、所使用的服务，以及退伍军人的人口统计学特征、健康状况和先前的医疗保健使用情况与使用广义估计方程（采用二项式族、logit链接和可交换相关结构）接受HCBS概率之间的关联。
每10名老年退伍军人中就有1人至少使用一项HCBS服务，且这一比例随时间推移在增加。退伍军人使用家庭医疗保健和家务助理/家庭健康助理服务的情况最为普遍。大多数退伍军人接受一项服务。我们发现，女性、黑人或被诊断患有痴呆症的退伍军人更有可能使用HCBS，而居住在农村地区的退伍军人使用可能性较小。
与老龄化平民人口面临的挑战一样，VHA面临着满足对HCBS不断增长需求的考验。了解这些动态对于确保HCBS在支持退伍军人方面既易于获得又有效至关重要。
