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DURHAM VA MEDICAL CENTER MEDICAL FOSTER HOME PROGRAM

DURHAM VA MEDICAL CENTER MEDICAL FOSTER HOME PROGRAM. Bonnie G. Garnette, MSW, LCSW-BACS Program Coordinator. WHAT IS A MEDICAL FOSTER HOME?. MEDICAL FOSTER HOME.

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DURHAM VA MEDICAL CENTER MEDICAL FOSTER HOME PROGRAM

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  1. DURHAM VA MEDICAL CENTERMEDICAL FOSTER HOME PROGRAM Bonnie G. Garnette, MSW, LCSW-BACS Program Coordinator

  2. WHAT IS A MEDICAL FOSTER HOME?

  3. MEDICAL FOSTER HOME • A Medical Foster Home (MFH) is an adult foster home combined with a VA interdisciplinary home care team such as VA HBPC (Home-Based Primary Care) or SCI-HC (Spinal Cord Injury Home Care), to provide non-institutional long term care for Veterans who are unable to live independently and prefer a family setting.

  4. What is Medical Foster Home? cont. • Merging of adult foster home with VA Home-Based Primary Care (HBPC) and/or Spinal Cord Injury Home Care program. • Person in community takes dependent veteran into their private home, as MFH caregiver • MFH caregiver provides daily personal care, assistance, and supervision • VA HBPC provides comprehensive medical care and management; caregiver education • VA MFH Coordinator provides oversight • Veteran pays for MFH

  5. How did MFH start? • Two social workers at Little Rock VA 1999 • Problem: Veterans in HBPC decline, not safe to live alone, refuse NH • Opposing ethical principles • Unsafe at home, or force out of home? • Solution – find a willing caregiver, meet medical care needs through HBPC • Pilot 2004 – in Tampa, Florida and San Juan Puerto Rico VA Hospitals

  6. Goals of MFH • Alternative to nursing home for certain Veterans • Meet increasing demand for LTC through care in non-institutional setting • Give Veterans option to remain in family setting • Improve quality of life for Veterans • Veteran in safe and therapeutic environment • Facilitate most appropriate use of VA and community resources • Provide longitudinal care in a home to include end-of-life and preventative care

  7. Benefits of MFH • VA offers an option to nursing home care, in a less restrictive environment • Veteran can choose a home environment • MFH less costly than nursing home • Cost savings to VA for 70%+ SC • Benefits to caregivers • Benefits to community

  8. Economics of MFH Who pays for MFH ? • MFH rates are negotiated according to level of care and Veteran’s ability to pay • Veteran pays for MFH • VA works with Veteran to receive proper level of Comp & Pension, Aid & Attendance • Other Veteran income; Social Security • 20% are 70%+ SC : Decline VA-paid NH

  9. MEDICAL FOSTER HOME CAREGIVERS

  10. MEDICAL FOSTER HOME CAREGIVERS • Complete an application and participate in an interview with the Medical Foster Home Program Coordinator and other staff as needed. • Be financially stable • Be at least 21 years of age.

  11. MEDICAL FOSTER HOME CAREGIVERS cont. Encouraged to: • Complete a financial statement • Provide results from a criminal background check • Provide at least four personal and professional references

  12. MEDICAL FOSTER HOME CAREGIVERScont. • Physically able to provide the needed care, have a written backup plan if they become incapacitated including relief persons. • Experience as a caregiver, formal or informal • Psychosocial assessment of everyone involved in the care of the Veteran

  13. MEDICAL FOSTER HOME CAREGIVERS cont. • Able to communicate with the Home Based Primary Care (HBPC)/SCI health care teams any significant changes in the veterans’ normal appearance, behavior or state of health. • Be willing to accept, participate in and follow the Veteran’s treatment plan.

  14. CAREGIVER KNOWLEDGE, SKILLS, AND EDUCATION Medical Foster Home caregivers are required to have the knowledge and skills in the following areas: • Provision of personal care specific to veterans’ level of functioning (Activities of Daily Living); • Medication management; • Crisis management and re-hospitalization procedures. • Provision of supportive and emotional care.

  15. CAREGIVER KNOWLEDGE, SKILLS, AND EDUCATION cont. • Nutrition and proper food preparation, distribution and storage. • Activity and program planning. • Applicable VA policies provided during MFH evaluation and educational opportunities offered by the VA. • Protecting the Veteran’s privacy and confidentiality. • State and local laws and ordinances. • Fire and safety procedures.

  16. Continuing Education • Will be obtained through appropriate channels, i.e., state/local programs. • Documentation of the training completed by the MFH caregivers will be maintained in the VA and the MFH records. • The HBPC/SCI/MFH programs will offer educational sessions periodically.

  17. Continuing Education • Topics may include, but not limited to: cultural diversity, ethics, HIPPA, infection control, communication, dementia, personal boundaries and conflicts of interest. • HBPC/SCI team members will provide ongoing education on the management of the individual patient’s medical and social needs.

  18. Finding a Caregiver • Drive: Compassion + Devotion, not money • Able and enthused for daily care • Long-term commitment • Patient will get worse, not better • Job will get harder, not easier • Accept unannounced visits • Still interested?

  19. THE MEDICAL FOSTER HOME RESIDENT

  20. Disabled Adults • "Disabled person" is defined as any person who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment. • "Major life activities" are defined as functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning and working.

  21. Who is a Candidate for MFH? • Veteran with disabling condition • Advanced chronic disease or terminal illness • Needs assistance & supervision; no caregiver • Unable to live independently due to functional, cognitive or psychiatric impairment • Meets nursing home criteria • Meets HBPC criteria – interdisciplinary care • Able to pay for MFH

  22. Medical Foster Home Residents • All are incapable of self preservation due to mental status and/or functional status:Mental status problems may be the result of dementia, traumatic head injuries, neurological diseases, or psychiatric disorders which include schizophrenia, obsessive compulsive disorder, and bipolar disorder

  23. Medical Foster Home Residents cont. • All are chronically ill with multiple complex medical problems • All need primary medical care and care coordination • All need medication---generally complex regimens

  24. Medical Foster Home Residents cont. • Virtually any patient that can be cared for in the home by a biological family member can be cared for in a medical foster home • Careful matching of patient “type” and caregiver is a necessity---and it may not be on target the first time.

  25. Medical Foster Home Patient Characteristics

  26. Medical Foster Home Residents with Medical Conditions • Average age ---76 • Range---50-97 • Race---primarily Caucasian • Number of major diagnoses---4 • Average diagnoses or medical problems---16

  27. Medical Foster Home Residents with Medical Conditions cont. • Average number of medications--- 12 • Majority are NON-SERVICE Connected • Limited income • Very limited family support

  28. Major Diagnoses • Dementia in over 50% • Heart disease • Hypertension • Diabetes • Significant Degenerative Joint Disease/Osteoporosis

  29. RECRUITMENT OF HOMES

  30. RECRUITMENT OF HOMES • Referrals may come from the individuals themselves or from other VA and non-VA personnel. • The prospective MFH caregiver may informally discuss the potential use of their home. • An application for participation in the MFH program must be made in writing by the prospective caregiver and forwarded to the MFH Coordinator.

  31. RECRUITMENT OF HOMES cont. • An initial assessment of the home to evaluate the caregiver’s predictors for success: strong interpersonal skills, good listening skills, and problem solving skills is completed by the medical foster home coordinator. • If the recommendation is positive, a formal inspection is scheduled. If negative, the applicant will be notified in writing.

  32. MEDICAL FOSTER HOMES - CRITERIA • Be located, designed, equipped, and maintained to ensure a home-like environment, and to provide safe care and supervision of all residents. • Be in a safe area as evidenced by acceptable results by the police and sheriff reviews.

  33. MEDICAL FOSTER HOMES - CRITERIA cont. • Caregiver must own or rent the home and the location of the home shall be the caregiver’s actual place of residence in compliance with VA and State regulations if licensed. • The medical foster home household optimally will include a married couple or a single caregiver.

  34. MEDICAL FOSTER HOMES - CRITERIA cont. • Meet all State, VA and local licensure requirements and regulations, including construction, fire, maintenance, and sanitation regulations

  35. Initial and Annual Follow-up Inspections • Must be inspected by a VA multidisciplinary team which includes a Fire and Safety Officer, Nurse, MFH Coordinator, Dietician and Rehabilitation therapist.

  36. MEDICAL FOSTER HOME ENVIRONMENT • Private or semi-private room • 24 hour supervision • Variety of relationships • Flexibility in daily routine • Choice of homes • Safeguards against abuse • Signed agreement between MFH and Veteran • Pets

  37. SERVICES AND SUPPORT TO THE MEDICAL FOSTER HOME • Home Based Primary Care (HBPC) • Mental Health Intensive Case Management program (MHICM) • SCI Home Care program • Respite program • HISA grants • Pharmacy • Prosthetics • Hospice program

  38. SERVICES AND SUPPORT TO THE MEDICAL FOSTER HOME cont. • Day Treatment Programs • Recreational Activities • Home Health Agencies • Support groups for Veterans in the community and at the VA • Training

  39. MEDICAL FOSTER HOMES - SAFETY • Inspections by VA team and others in the community as needed. • Fire Extinguishers • Emergency Exits • Emergency Preparedness • Fire Drills

  40. MEDICAL FOSTER HOME - INFECTION CONTROL • TB testing/x-rays • Avian Influenza/Regular “Flu” (recommended) • Washing Hands • Safe meal preparation

  41. ROLE OF THE MEDICAL FOSTER HOME COORDINATOR

  42. COORDINATOR WEARS MANY HATS • Recruits medical foster homes • Inspects and approves medical foster homes • Process referrals of Veterans to MFH program • Match patient to foster home • Arrange trial visits if necessary

  43. COORDINATOR WEARS MANY HATS cont. • Assist with Veteran’s application process for VA pensions & Social Security • Coordinate VAH discharges & placement to MFH • Maintenance & support of placement • Conducts unannounced visits to MFH • Keeps statistics and completes reports as requested. • Conducts quality assessments for Veterans, their families and caregivers.

  44. QUESTIONS?

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