LGBTQ+ inclusivity of the U.S. Department of Veterans Affairs’ Home Based Primary Care services

Abstract Background and Objectives: LGBTQ+ veterans are more likely to require home care services than non-LGBTQ+ veterans. Yet, evaluations of how these services accommodate older LGBTQ+ veterans are scarce. This study assesses the state of LGBTQ+ inclusion in the U.S. Department of Veterans Affairs’ (VA) Home Based Primary Care (HBPC) program. Research Design and Methods: Using a mixed-method approach, we conducted a national survey of VA HBPC staff, focus groups at three sites, and interviews with LGBTQ+ veterans served by HBPC. Results: Of approximately 10,000 HBPC staff invited to participate, 321 completed the survey. Respondents included nurses and physicians (31%), social workers (20%), psychologists (13%), and other staff (36%). Most reported minimal training on LGBTQ+ care, with over half (54%) receiving fewer than three hours in the past five years. Despite this, 89% agreed they were aware of the unique challenges faced by LGBTQ+ veterans. Regarding community resources, 71% endorsed confidence in finding affirming community providers. In both surveys and focus groups, VA HBPC staff noted a strong desire for training in LGBTQ+ care and disagreed over how much control they have in determining affirming care for older LGBTQ+ veterans in the community. In interviews, four LGBTQ+ veterans expressed satisfaction with HBPC services and a need for more social connections. Discussion and Implications: Opportunities to increase training for HBPC staff could improve access to affirming VA and community services, and are desired by most HBPC staff. Tailoring services for older LGBTQ+ veterans is needed to enable exemplary care for all veterans.