In fiscal year 2020, the Department of Veterans Affairs (VA) is projected to spend $9.8 billion on long-term care services for eligible Veterans. Recent legislation have created and expanded VA programs to support informal caregivers (ie, family or friends who provide unpaid care for Veterans with substantial impairments). A substantial proportion of Veterans with impairments served after September 11, 2001; there is a higher prevalence of mental health conditions for this younger group, and their caregivers are more likely to lack social support networks.
In 2017, the VA Secretary launched the Choose Home Initiative to enhance VA policies and practices for supporting Veterans and their informal caregivers, and to improve collaboration with non-VA community groups. To help VA policymakers understand the effects of VA-provided or -funded home and community-based services (HCBS), particularly with regard to avoiding long-term nursing home placement (NHP), the VA Evidence Synthesis Program (VA ESP) was asked to examine evidence on modifiable risk factors for long-term NHP and interventions that aimed to delay long-term NHP for community-dwelling adults with physical and/or cognitive impairments.
We sought evidence for both adults with existing disabilities (or at high risk for developing impairments) and individuals with posttraumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). To address the broad scope of questions for these diverse populations and to provide specific recommendations for VA policies, we undertook an umbrella review of systematic reviews. We present qualitative summaries of results from the highest quality and most recent reviews covering the largest range of risk factors and interventions. We also describe policy implications and evidence gaps.