Home Assessments and Modifications Within the VHA: Preliminary Analysis of Providers’ Experiences – Rural Focus

Research Objectives: Describe the home modifications (HM) process within the Veterans Health Administration (VHA) and identify HM challenges and facilitators.

Design: Qualitative description.

Setting: VHA healthcare.

Participants: Volunteer sample of 15 VHA providers (n=13 occupational therapists, n=1 physical therapist; n=1 kinesiotherapist) having HM experience within 4 years, recruited from nationally distributed email invitations.

Interventions: Not applicable.

Main Outcome Measures: Individual interviews were conducted using a semi-structured guide on VHA-licensed Microsoft Teams; interviews were recorded and transcribed. Thematic analysis was used to answer research questions: (1) What are barriers and facilitators of HMs for rural Veterans?; (2) How are video technologies incorporated into HM processes?

Results: Preliminary themes are: (1) barriers and strategies in the HM process, (2) building and utilizing Veteran and caregiver rapport within HM, (3) disciplinary nuances in VHA home assessments and modifications, and (4) incorporation, trade-offs, and promise of telehealth in HM. Providers navigate challenges of built environment, social/familial preferences, and technological, mechanical, and geographical barriers while deploying strategies and resources to facilitate timely and comprehensive HM. Challenges experienced during in home and video remote HM are exacerbated by Veteran’s factors such as age, severe or rapidly declining condition, and the spouse’s condition and preferences regarding recommended modifications. Accessing community resources for HM are more challenging in rural areas.

Conclusions: Notwithstanding largely positive experiences providing telerehabilitation, most providers prefer in-home HM assessments and report using video telehealth more often for follow ups to verify correct equipment use and fit. Telehealth technologies provide benefits in improving HM access, convenience, and timeliness of care and are used in exclusively remote HM service models, hybrid in-home/remote models, and as adjuncts to primarily in-home HM processes.

Author(s) Disclosures: Authors report no conflicts of interest.