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CU College of Nursing - Research Stories

College of Nursing

Study evaluates medical foster homes as alternative to nursing homes

Determined to help older veterans "stay in place"

Nurse at home

​Jacqueline Jones, PHD, RN, is on a mission to help older veterans “stay in place.” Her passion stems from a personal and professional conviction that older veterans should be able to be in a place that feels like home.


Jones is co-investigator with Cari Levy, MD, PhD, the principal investigator and a physician at the VA Hospital, in a study to assess whether Medical Foster Homes, a VA model, can provide safe, cost-effective alternatives to nursing homes for older veterans. The original research in Denver, published in the Journal of Nursing Practice and Education (online, September 2013), led to the current national study.


For the past two years, Levy, Jones and colleagues have been collecting qualitative data at sites around the country where medical foster homes are in place. The on-site visits—in Arkansas, Minnesota, Florida, South Dakota, Maryland and Oregon— last two to three days. The team interviews veterans, caregivers, family members and medical foster home site coordinators, and conducts focus groups with each site’s home-based primary care teams. They also assess high- and low-enrollment programs across the nation.


“I’m passionate about keeping older adults in their ‘home’ for as long as they wish and as long as they can be supported by services coming into the home,” says Jones, whose research in “aging in place” has informed national policy in her native Australia.


“Veterans have served their country and are often vulnerable and at a disadvantage as they age, and often end up in a nursing home, like many non-military older adults.”


In the Denver study, three themes emerged as key factors to the success of the Medical Foster Home (MFH) model: environment, for veterans to have a safe and comfortable space; the match, a collaborative relation- ship among veterans, care providers and the medical team providing care within the home; and perceptions and expectations, about the ability to meet needs and challenges related to health concerns, relocation and costs.


“The key is the match between the caregiver and the vet,” Jones says. There are cultural factors to consider as well. “Different places have different groups of people and cultures, and many veterans like to be very independent.” Not all veterans “are of the same ilk,” she continues, and “health needs are broad in scope, as all MFH veterans are eligible for nursing home placement.”


Homes that volunteer to be medical foster homes are screened and caregivers are monitored. People who volunteer their homes to veterans aren’t in it for financial reasons, Jones says. Although care providers may have a contractual agreement for some reimbursement with the VA, “they’re in this because they want to give something back” to the veterans. “It’s a 24-hour-a-day job, and some people have even modified their homes for the veterans.  


The VA provides respite, and the coordinators say it’s pretty obvious the caregiver is in it for the right reasons. It’s very touching to see the commitment.” Family members who may not be in a position to have a veteran live with them due to geographic considerations are encouraged to be in regular communication with the medical foster home caregivers. Caregivers and family members often form a partner- ship, Jones says. Jones also has collaborated with the VA’s Evelyn Hutt, MD, in a study titled “Developing a Palliative Care Service for Homeless Veterans.” Hutt asked Jones to be the co-PI because of her experience in developing multi-level qualitative research that informed national policy on health care for older adults in Australia. “The aim of this study is to bring together the best of palliative care programs across the VA system with the best of programs for homeless veterans,” Jones says. “Then we’ll be able to develop an integrated service model for excellent end-of-life care for homeless veterans that can be applied nationally.”


As part of the palliative  care study, Mary Weber, PhD, associate professor at the College of Nursing with extensive experience working with the homeless, is also collecting data by interviewing homeless veterans. “The same principle  of aging in place in a Medical Foster Home applies to homeless veterans a more extreme example of being displaced from a safe home as their health deteriorates,” Jones says.


In either study, “The goal is to keep veterans in the ‘home’  of their choice with appropriate support until the end of  their life."