Utilization and Cost Effects of the VHA Caring for Older Adults and Caregivers at Home (COACH) Program

Wei Song
Orna Intrator
Jack Twersky
Judith Davagnino
Bruce Kinosian
Darryl Wieland
Peer-Reviewed Article
July 2020


Training for caregivers of veterans living with dementia may help them remain in their home longer, but may lead to increased health care costs.


Caregiver training is linked to improved caregiver well-being and better outcomes for those they care for. The Veterans Affairs Caring for Older Adults and Caregivers at Home (COACH) program aims to increase access to needed services for veterans living with dementia and their caregivers and enable them to remain at home for as long as possible. The COACH program provides patient assessment and care management, as well as caregiver education, support, and behavioral training. This study evaluates the impact of the COACH program on health care utilization and spending.


Improved access to services through the COACH program was associated with reduced long-term nursing home care, allowing veterans to remain in their homes longer. However, COACH increased use of emergency services and personal care services and health care costs were significantly increased.


COACH holds promise for supporting veterans living with dementia to stay in their homes longer and have better access to services offered through the Veterans Health Administration and Medicare. Health care organizations can offer education and support to caregivers of people living with dementia to help reduce long-term institutionalization.

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