Bridging the Gap: Navigating VA Service to Optimize Care Melonie Blair-Fabian, DCSW, ACHP-SW
Introduction & Goals Transitioned from a private sector social worker to a VA hospice social worker in 2012 and began questioning how common my experience was. Goals: Acknowledge perceptions about the VA Validate Twilight Zone experiences Identify productive ways to move forward Making a difference for one Veteran makes it all worth it.
Unique End of Life Issues 22 million Veterans in the US: 1 in 4 people dying each day are Vets 95 % of Veterans die OUTSIDE of the VA, which is why I m here today.
VA Mission: Adopted in 1959 from President Lincoln s 1865 Inaugural Address: To care for him who shall have borne the battle and for his widow, and his orphan SERVE: 1. to render assistance; be of use 2. to be useful 3. to have definite use
Who is VA? 356K EMPLOYEES 32% VETERANS.5% National Cemetery Administrati on 3.7% VA Central Office 89% Veterans Health Administrati on 6.2% Veterans Benefits Administrati on 194K Female Employee s Source: va.gov/vetdata PR O JE C TE D U.S. VE TE R A N PO P U LA TIO N : 22.2 MILLION5
Veterans Are Our Customers The World Wars 1.7 million Korea and Vietnam 9.7 million Gulf Wars 2.4 million Global War on Terror 2.3 million 5.5 MIL LIVING PEACE TIME VETERANS 6
Our Administrations Veterans Benefits Administration Veterans Health Administration VA Central Office National Cemetery Administration 7
Overview of Benefits and Services Veterans Benefits Administration (VBA) Veterans Health Administration (VHA) National Cemetery Administration (NCA) Provides financial and other forms of assistance Provides health care Provides burial benefits and manages VA s National Cemeteries 8
VBA Facts In 2015 VA processed the highest number of disability compensation VBA and completed pension 1.32 claims million in 2014 in history 1.4 Million claims! Approximately 50% of VBA employees are Veterans VBA delivered over $62.4 billion in 9/11-Post GI Bill Education Benefits to over 1.57 million Veterans and eligible family members since 2009 Source: va.gov/vetdata Over 4.5 million Veterans currently receive compensation benefits VA assisted 89,000 Veterans in avoiding home foreclosure 9
VHA Facts VHA provides care at 168 VA Medical Centers and 1047 outpatient sites of varying complexity of care VHA serves 8.3 million each year In 2015, 534,000 phone calls were answered on the Veterans Crisis Line The Women Veterans Call Center made 183,000 calls to women Veterans to share information about VA services they may be eligible for from FY13-FY15 VHA operates the nation s largest integrated health care system Source: va.gov/vetdata 10
National Cemetery Association NCA topped the American Customer Satisfaction Index s survey of customer satisfaction for 5 consecutive times. NCA currently maintains 3.5 million gravesites NCA scored a 96 out of 100, the highest mark for any organization in the history of the American Customer Satisfaction Index 4.3 million Veterans and their family members have been laid to rest in VA cemeteries 75% of NCA employees are Veterans Source: va.gov/vetdata 11
NCA Services Services Include: Burial Spaces for Veterans and Eligible Family Members in Any of the National Cemeteries with Available Space, or a VA-Funded State Cemetery The Opening and Closing of the Grave Perpetual Care of the Graves Headstones, Markers, and Bronze Medallions Burial Flags Presidential Memorial Certificates Construction Grants for State and Tribal Cemeteries All of these benefits are provided at no cost to the family. VBA pays a burial and plot allowance for those Veterans eligible by law. 12
Burial Benefits Veterans or their family members can prepare for burial in a National Cemetery by: Providing appropriate loved ones with a copy of his/her DD Form 214 (Report of Separation from Active Military Service) Informing family members of their wish to be laid to rest in a national, state or tribal Veterans cemetery To learn more, visit: www.va.gov https://www.archives.gov/veterans/military-servicerecords 13
VA Geriatric & Extended Care Geriatrics and Extended Care Services (GEC) is committed to optimizing the health and well-being of Veterans with multiple chronic conditions, lifelimiting illness, frailty or disability associated with chronic disease, aging or injury. Home and Community Based Services: Services help chronically ill or disabled Veterans of any age remain in their homes. These services can include: skilled home health, homemaker/home health aide, in-home respite care, home hospice, contracted adult day healthcare and contracted community nursing home care. Vets can receive more than one service at a time.
Home Hospice Home hospice services are provided in the community in home settings Veterans may chose to use their Medicare or private insurance When hospice services are in place, a comprehensive package of services is provided: skilled nursing, palliative therapy, social worker, chaplain services, volunteer services, inpatient respite, home health aide, equipment and medications
Skilled Home Care In home services that include: Skilled Nursing Physical Therapy Occupational Therapy Speech Therapy Social Work Services For assessment, treatment planning and provision, education, health monitoring, reassessment, referral and follow-up.
Respite Care Respite care services are personal care and supportive services delivered in the home setting, nursing home, ADHC or assisted living for purpose of temporarily relieving caregiver(s) of care-giving duties There is currently a 30 day per year limit
Homemaker/Home Health Aide H/HHA services are personal care and related support services that enable frail and disabled Veterans to live at home Homemaker: assistance with IADL s: light housekeeping, laundry, meal prep etc. Home Health Aide: assistance with ADL s: bathing, toileting, dressing, transfers etc.
Contract Adult Day Health Care (CADHC) Targeted for Veterans at risk for nursing home placement, i.e. similar criteria to H/HHA Goal is to provide care in least restrictive setting Therapeutic environment to improve Veteran s physical and mental well being Average number of days/week is three May include transportation to and from home and CADHC
Contract Community Nursing Home (CNH) A Community Nursing Home is a place where Veterans can live full time and receive skilled nursing care any time of the day or night VA contracts with community nursing homes to care for Veterans. The Community Nursing Home program is offered in many locations so Veterans can receive care near their homes and families CNH s can provide: long term care, short term rehab, respite, hospice and palliative care for the end of life and specialized care for dementia
Home Based Primary Care (HBPC) Health Care in the home of home-bound Vets with multiple medical problems. Interdisciplinary team providing medical, nursing, social, nutritional and rehabilitative services. Goals: Optimize health and quality of life Reduce hospitalization and frequent clinic visits Maintaining optimal independence in daily living. Collaborating with community and VA resources to provide care for Veterans in the home throughout end-of-life.
Medical Foster Home Grew out of need identified by HBPC. Small private homes in the community with a max of 3 Veterans. Provides an alternative to institutional placement, which better suits the psychosocial needs of Veterans (PTSD, homelessness, substance abuse). Veterans become members of the family.
Inpatient VA Hospice Units Incorporated into Community Living Centers at VA Medical Centers. Provide inpatient care for Veterans in last weeks to months of life. Veterans are not charged for inpatient hospice care. Veterans often graduate from the unit.
Demographics
Case Example #1 Mr. Smith Vietnam Era Veteran admitted to hospice unit for lung cancer diagnosis. Vet harbored much anger toward VA and had avoided contact since discharge. Loving and supportive wife at time of assessment, but then suddenly stopped visiting. Staff thought she had abandoned Vet. Veteran Benefit Counselor education on Presumptive Conditions VA Service Connected Pension & Survivor s Pension
Agent Orange Exposure Acute and Subacute Peripheral Neuropathy AL Amyloidosis Acute and Subacute Peripheral Neuropathy AL Amyloidosis B Cell Leukemias Chloracne (or Similar Acneform Disease) Chronic Lymphocytic Leukemia Diabetes Mellitus (Type 2) Hodgkin s Disease Ischemic Heart Disease Multiple Myeloma Non-Hodgkin s Lymphoma Parkinson s Disease Porphyria Cutanea Tarda Prostate Cancer Respiratory Cancers Soft Tissue Sarcoma
Case Example #2 Ralph: WWII Veteran who was running out of resources to pay for assisted living. NSC Pension, Aid & Attendance and Retroactive Benefits World War I (April 6, 1917 November 11, 1918) World War II (December 7, 1941 December 31, 1946) Korean conflict (June 27, 1950 January 31, 1955) Vietnam era (February 28, 1961 May 7, 1975 for Veterans who served in the Republic of Vietnam during that period; otherwise August 5, 1964 May 7, 1975) Gulf War (August 2, 1990 through a future date to be set by law or Presidential Proclamation) Placement in Medical Foster Home until needs became too great, then admitted to inpatient hospice unit.
Case Example #3 Larry Receiving Community Hospice Serves Under Medicare Due to Hospice Veteran Partnership, Hospice SW reached out to me for evaluation of services to assist with: Caregiver fatigue (VA respite services) Financial Concerns (VBC referral) Process Improvement resulted in local community hospices alerting VA when a Vet was admitted to their program to evaluate for eligibility.
More Information VA 311 1-844-698-2311 Veterans Crisis Line Homeless Benefits Regional Offices Health Care Centers Pensions GI Bill Home Loans Burial Benefits www.vets.gov www.explore.va.gov 29
Contact Information: Melonie Blair-Fabian, DCSW Medical Foster Home Program Coordinator Northern Arizona VA Health Care System 500 N Hwy 89 Prescott AZ 86313 Cell: 928-460-0214 Office: 928-776-5439 Melonie.blair-fabian@va.gov