UNMET NEEDS OF VETERANS AND CAREGIVERS INCREASE WITH PREDICTED RISK OF LONG-TERM INSTITUTIONAL CARE

Abstract To understand unmet needs, we contacted a random sample of Veterans receiving care at five Veterans Health Administration (VHA) sites and oversampled Veterans with a higher predicted 2-year LTIC risk. Veterans and their caregivers were asked to complete separate comprehensive surveys to assess demographic, social, psychological, functional, and physical domains; unmet needs; experience with home and community-based services; and caregiver support programs experience. Veteran and caregiver surveys were mailed in the same envelope to 20,000 Veterans. We received responses from 8,056 Veterans and 3,579 caregivers. Veteran respondents were mostly men (96.5%), over 65 years (94.9%), married (55.0%), Non-Hispanic White (75.2%), and residing in urban areas (80.7%). Veterans reported unmet needs in activities of daily living (ADLs; 15.7%), instrumental activities of daily living (IADL: 26.0%), nursing tasks (7.9%), pain management (15.1%), communicating with healthcare team (18.2%), and social support (12.1%). The most common unmet IADL needs were medication management (55.4%), housework (55.4%) and preparing meals (53.7%). Compared to Non-Hispanic Whites, Hispanics and Non-Hispanic Blacks were more likely to have unmet ADL and IADL needs. Caregivers averaged 7.3 hours of daily care (SD=5.5 hours); and helped with ADLs (42.5%), IADLs (57.2%), communicating with healthcare team (52.4%), and social needs (36.4%). Degree of need for assistance for all needs varied by predicted risk of institutionalization (PLI). Veterans in the high PLI tier reported the highest prevalence of unmet need. Both Veterans and caregivers described complex unmet needs in medical, functional, psychological, and social domains, which increased as their predicted risk for LTIC increases.