using community health workers to support rural care partners of seriously ill older veterans

Conditions: Dementia; Cancer; Renal Disease; Obstructive Pulmonary Disease

Summary: the investigators aim to support care partner's well-being and satisfaction with va care and decrease their work burden by offering extra support from a trained community health worker who will help connect the care partner to helpful resources in their communities and in the va. the investigators also hope to help veterans well-being and satisfaction with va care by supporting their care partner more sufficiently allowing the care partner to focus on caregiving tasks.

aim 1: determine csnav effectiveness in increasing rural veterans' well-being, reducing rural care partner burden, and increasing rural care partner/veteran satisfaction with va care in the intervention group compared with the usual care (csp) group. the investigators will apply a 6-month intervention in a randomized control trial over 27 months. primary outcome: (h1) care partners randomized to intervention group will have lower mean zarit-1216 burden scores at 6 months compared to the control group. secondary outcomes: (h2) care partners and veterans randomized to the intervention group will have higher mean cahps global satisfaction17 scores at 6 months compared to the control group. (h3) veterans randomized to the intervention group will have higher mean warwick edinburgh mental well-being scale18 scores at 6 months compared to the control group. aim 2: following intervention, the investigators explore veterans' and care partners' experience of chws as a mode of va support using semi-structured interviews. the investigators then facilitate delphi method sessions with the community advisory board plus study veterans/care partners, chws, and key operational partners to examine aims 1 \& 2 data for intervention improvements and implementation planning using updated cfir.19 aim 3: conduct budget impact analysis from the va perspective to evaluate cost-drivers and assess feasibility to inform adaptation and implementation of the intervention within a va regional network.

Eligibility criteria:
inclusion criteria: care partner inclusion criteria * a relative, friend, or partner (18 years of age) with whom veteran patient has a personal relationship who assists veteran regularly with care and/or care coordination as defined under "veterans" below * residing in a rural area based on rucc or rural-urban continuum codes83 * must be enrolled in csp program of general caregiver support services * can live with or separately from the veteran; able to communicate in english by phone veteran inclusion criteria * receiving care at durham, asheville, and richmond va health systems (e.g., at least 2 outpatient visits in past year; has a primary provider) and residing in a rural area. * diagnosed with congestive heart failure, chronic obstructive pulmonary disease, cancer, dementia, or end-stage renal disease. * requires assistance with at least one adl (i.e., walking, feeding, toileting, transferring, bathing, or dressing) or iadl (i.e., transport, medication, financial management, shopping, or meal preparation) * 50 years old or older and able to communicate in english by phone (for assessments) exclusion criteria: veteran exclusion criteria * flag or social work note indicating suspected caregiver abuse. * unable to communicate in english by phone for assessments.