July 26, 2022 — Susan Snead lived in an apartment complex for the elderly. The resort had a nice day room and neighbors knocked on its door from time to time to check in.
But while not alone, Snead, 89, lived alone in downtown Charleston, South Carolina. Eventually it got dangerous.
“I fell several times,” she says. “I had to call someone to pick me up.”
Sometimes help came from the apartment complex office. Sometimes he came with a police escort.
Over time, having to make these calls has become a burden. Making and keeping appointments with her doctor, which she had to do regularly because she has diabetes, has also become more difficult.
“It wore me out a bit,” she says. “Like you’re walking up a hill.”
As she began to accept that she could no longer live on her own, Snead, an Air Force veteran, heard about a program run by the Department of Veterans Affairs called Medical Foster Home.
Medical Foster Homes are private homes in which a licensed caregiver lives with residents and supervises them 24 hours a day. Caregivers help aging Veterans with activities of daily living such as bathing, cooking, taking and going to appointments, getting dressed and taking medication daily.
Caregivers can care for up to three residents at a time in their home. Although most residents are veterans, caregivers sometimes care for non-veteran residents, such as a veteran’s spouse or a family member of a caregiver.
Veterans typically pay between $1,500 and $3,000 per month for the service, depending on location.
According to the VA, the concept of medical foster homes has been around since 1999, when VA hospitals across the country began reaching out to people wanting to provide home care for veterans. The option is run by local VA hospitals, which approve caregivers and provide administrative services. There are now 517 medical foster homes, according to the VA.
Just like other residential care facilities, medical foster homes are subject to regular inspections for safety, nutrition, etc.
In 2019, Snead signed up for the program. She expected to be cared for, but found a sense of family with her caregiver, Wilhelmina Brown, and another veteran at home.
Brown began caring for people — though not necessarily veterans — in 1997 when her grandmother was unable to care for herself, she says.
“My grandmother carried me to church every Sunday, she carried me to the beach — everywhere she went, she took me with her,” Brown says. As her grandmother grew, “I said, ‘I’m going to take care of her at my house.'”
Caring for others should come from the heart, says Brown.
She prepares meals for her residents three times a day taking into account dietary restrictions, washes their dishes, does their laundry, remembers birthdays and organizes small parties.
“It’s my family,” Brown said.
In 2020, COVID-19 pandemic turned the world upside down – but at the same time highlighted the benefits of the medical foster home model.
Home-based primary care keeps veterans out of nursing homes – something that has become especially important with COVID-19 hitting nursing homes and long-term care facilities.
System caregivers have also been able to help veterans, often living in rural areas, pivot and adjust to telehealth in times of crisis.
A studypublished in the journal Geriatrics in June 2022 set out to identify how medical foster homes were able to provide safe and effective health care during the early stages of the pandemic.
Researchers interviewed 37 VA care providers in 16 rural medical foster home programs across the country. Interviews took place between December 2020 and February 2021. They found that caregivers, coordinators and medical care providers at foster homes communicated to move home office visits, helped veterans navigate in telehealth, advocated having veterans vaccinated at home and leaned on each other to fight society insulation.
Caregivers also adapted quickly to telehealth, according to Leah Haverhals, PhD, health researcher and director of communications for the Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, who led the study.
Most veterans in the foster home program are older and find new technologies difficult to use.
Caregivers, coordinators and healthcare providers were also largely new to the technology.
Although the study found that most veterans and caregivers preferred in-person care, they were able to work together to get the most out of telehealth.
“It speaks to the nature of the care given, the ability to pivot in a crisis like this,” says Haverhals.
If caregivers didn’t already have computers or telehealth-enabled devices, the VA provided iPads that connected to the Internet using cellular signals. According to the study, this helped overcome connectivity issues that may have caused problems in rural areas.
Snead says Brown has helped her a lot with her telehealth calls.
“If we had to do things over the phone or video, she was able to set that up to work with the person on the other end of the line. She knows a lot about that stuff – about computers and things like that,” Snead said, adding that she hadn’t worked with computers since. retirement in 1998.
Telehealth has helped healthcare providers identify infections and quickly prescribe antibiotics to veterans in rural areas and provide other care delivered more safely in private homes.
“The results of our study highlighted that when we work together for the common goal of keeping vulnerable populations like veterans in MFH [medical foster homes] safe in times of crisis, adaptation and collaboration facilitated the continued delivery of high-quality care,” Haverhals’ group wrote. “Such collaboration has proven essential in recent research in the United States on support for the elderly during the pandemic.”
Cari Levy, MD, PhD, a professor at the University of Colorado School of Medicine and co-author of the study, specializes in palliative care and home nursing for VA.
Levy, who has worked for the VA for about 20 years, explains how medical foster homes provided care during the pandemic hold lessons for civilian clinics. One of the most important lessons, she says, is that healthcare professionals will need to provide more care where people are, especially in populations that are too sick to come to the clinic.
“For years there was all this hope that telehealth would grow,” but it took a pandemic to allow approval from federal agencies to skyrocket, she says. “I shudder to think of what would have happened if we hadn’t had telehealth. Fortunately, it was the right moment to be able to activate a switch.
Crisis aside, Levy says she dream would be for health care providers to provide more home care. The model allows people to preserve the relational aspects of medicine, which can thwart much of the moral hurt and burnout, she says, adding:
“I see it as the kind of medicine that a lot of people intended to do when they got into medicine.”