Understanding Home Modification Provision in Rural and Urban Areas within the Veterans Health Administration

Research Objectives To compare home modification provisions within the Veterans Health Administration between rural and urban areas. Design A retrospective descriptive study. Setting Veterans Health Administration (VHA) in VA Sunshine Healthcare Network (VISN 8). Participants 117,690 Veterans enrolled in the Veterans Health Administration in Florida, South Georgia, Puerto Rico, and the U.S. Virgin Islands during the fiscal year 2019. Interventions Not applicable. Main Outcome Measures Not applicable. Results In fiscal year 2019, 19.7% of enrolled Veterans in VISN 8 (23,170 out of 117,690) received home modifications. There were no differences in percentages between rural and urban Veterans. Rural Veterans who received modifications were younger (mean age 71.1, SD 12.4) but had more health conditions (mean 18.7, SD 9.4) than urban Veterans (mean age 72.2, SD 13.8, the mean number of conditions 17.1, SD 8.9). Common medical conditions among Veterans receiving home modifications included "Essential hypertension" (71.2%), "Disorders of lipid metabolism" (59.8%), "Type 2 Diabetes" (44.3%), "Musculoskeletal pain" (40.4%), and "Low back pain" (37.9%). Rural Veterans had significantly higher rates of these conditions compared to urban Veterans (P<.05). The most ordered equipment for those receiving home modifications were bath or shower chairs (43.6%), bathtub grab bars (29.7%), and tub stools or benches (22.1%). Rural Veterans were less likely to receive them (χ21=12.3, P=.001; χ21=10.8, P=.001; χ21=341.5, P<.001). Conclusions This study revealed no differences in access to home modifications across rural and urban locations, highlighting the VA's commitment to equitable access. However, since rural Veterans had a higher number of health conditions, there might be opportunities to provide additional home medications to support them. VA should continue to provide home modification services to help Veterans manage their health in their home environments and maximize function. Author(s) Disclosures Authors report no conflicts of interest.