Empowering Older Veterans Through Self-Directed Care: A Mixed Methods Evaluation of a Technology Enabled Respite Homecare Model Pilot.

To remain living independently, many older and disabled adults rely on homecare workers, though workforce shortages and turnover can hinder access to care. The Veterans Health Administration piloted a Technology Enabled Respite Homecare Model allowing Veterans to select their homecare aide in collaboration with a coordinating agency to expand access to services. We used a convergent mixed method design, surveying Veterans (n = 97) and homecare aides (n = 110) and conducting qualitative interviews with staff (n = 8). Forty-four percent more Veterans accessed in-home care after enrollment compared to before and satisfaction was high (8.6 out of 10). Homecare aides were also satisfied (8.0 out of 10) and reported receiving $3.11 higher hourly compensation. Staff found no major changes to workflow but suggested nursing oversight, staff education, and communication coordination to improve implementation. Overall, this pilot increased Veteran access to in-home care, demonstrating one approach to filling gaps in unmet needs for older adults.