james hallenbeck, md associate chief of staff, extended care, va palo alto health care system,...
TRANSCRIPT
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James Hallenbeck, MDAssociate Chief of Staff, Extended
Care, VA Palo Alto Health Care System,
Associate Professor, Stanford University
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California Veterans2.2 Million (6%) of California population
Of these…94% men, 6 % women35% of veterans are > age 65 (10.6 % overall
pop. > 65)21% of Californians > 65 are veterans> 60% of Californian men > 65 are
veterans
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Think of the VA when…• A veteran tells you that he/she is enrolled at a
particular VA facility• Funding difficulties – ineligible for Medicare,
MediCal and no private insurance• Military/Veteran-related issues arise
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Think of the VA when…• Special clinical needs
– Related to military service– Mental Health issues/PTSD
– Needs adjunctive care to stay at home– Homelessness– Blind
• Concern about benefits
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VA FacilitiesHave discrete catchment areasAssociated Clinics (Community Based
Outpatient Clinics – CBOCs)Veterans enrolled at a particular facility
Encouraged to have primary care provider
VA Medical Centers function much like a managed care
organization like Kaiser.
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EligibilityPrioritization of veterans with Service-
Connected DisabilitiesDiffering eligibility standards for
Outpatient/Home/Acute care and Nursing Home CareOutpatient/acute: basic eligibilityLong Term Nursing Home: highly SC only
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Is VA Care a Form of Insurance?Yes and No
Yes: for enrolled veterans receiving VA through VA (like Kaiser)
Yes: for some care for highly service-connected veterans outside VA (acute care hospitalizations)
No: For most other types of care outside the VA
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Example: Hospice CareVA Hospice Benefit – mimics MedicareEspecially useful for veterans <65 without
MedicareFor enrolled veterans as ordered by a VA
providerNot intended for un-enrolled veterans calling a
VA facility to get them to cover care
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Home Care ServicesHome-based Primary Care (HBPC)
Homebound, VA primary care provided at home, geographically restricted areas
Homemaker/Home Health Care (H/HHA)Very similar to IHSSPurchased from community agencies
Contract Adult Day Care (CADHC)
Note: VA largely blind to parallel services, such as IHSS
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Home Care ServicesPurchased Home Care
Skilled nursing care at home (like Medicare Home Care)
Hospice Care (similar to Medicare)Spinal Cord Home Care (by VA providers)Emerging programs:
Medical Foster Home programVeteran Directed Care
Unlike Medicare, all purchased VA home care prospectively authorized
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Nursing Home CareVA Nursing Homes (Community Living
Centers, CLCs)Short-stay rehab/post hospitalLong term care for highly 60% + SC veterans
Community Nursing Home (CNH) program
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ChallengesTwo-way lack of knowledge
Community organizations do not understand VAMany VA providers equally ignorant of
community resources
Common complaint about VA – don’t know who to talk with/ poor contact information.
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The Great MythCare of veterans the sole responsibility of the
VAReality: only 26% of veterans cared for by VA
in any given year Many of these veterans receive only some of their
care through VA
Given this, optimal care for veterans requires collaboration between VA and community
organizations
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SuggestionsIncorporate routine inquiry regarding
veteran status into assessmentsAssess enrollment status, service-connectionIf enrolled – which VAMC
Become familiar with unique VA services and where VA can “plug holes”
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Special VA ServicesSome Home Care ServicesSpinal Cord InjuryMental Health Services
PTSD, Substance abuseCare for Homeless Veterans (residential
programs, HUD/VASH (voucher) programHospice/palliative careBlind rehabilitation programs
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Cultivate Your Contacts at Local VAMCs!
Admissions and EligibilityCaregiver Support ProgramHome CareGeriatrics and Extended CareHomeless Veteran Program CoordinatorsPatient AdvocateVeteran Service OfficersADRC points of contact
Note: Quality of facility websites- variable. When in doubt, call
program offices
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SummaryVA provides excellent healthcare – with some
benefits not readily available through the community
Navigating the VA labyrinth can be challenging
It is all about relationships and communication
Together, we can do a better job serving those who have served!