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A Quick Primer on “the VA” for ADRCs

A Quick Primer on “the VA” for ADRCs. James Hallenbeck, MD Associate Chief of Staff, Extended Care, VA Palo Alto Health Care System, Associate Professor, Stanford University james.hallenbeck@va.gov. California Veterans. 2.2 Million (6%) of California population Of these…

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A Quick Primer on “the VA” for ADRCs

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  1. A Quick Primer on “the VA”for ADRCs James Hallenbeck, MD Associate Chief of Staff, Extended Care, VA Palo Alto Health Care System, Associate Professor, Stanford University james.hallenbeck@va.gov

  2. California Veterans • 2.2 Million (6%) of California population • Of these… • 94% men, 6 % women • 35% of veterans are > age 65 (10.6 % overall pop. > 65) • 21% of Californians > 65 are veterans • > 60% of Californian men > 65 are veterans

  3. 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

  4. 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

  5. A Deeper Dive into VHA

  6. VA Facilities • Have discrete catchment areas • Associated 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.

  7. Eligibility • Prioritization of veterans with Service-Connected Disabilities • Differing eligibility standards for Outpatient/Home/Acute care and Nursing Home Care • Outpatient/acute: basic eligibility • Long Term Nursing Home: highly SC only

  8. 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

  9. Example: Hospice Care • VA Hospice Benefit – mimics Medicare • Especially useful for veterans <65 without Medicare • For enrolled veterans as ordered by a VA provider • Not intended for un-enrolled veterans calling a VA facility to get them to cover care

  10. Home Care Services • Home-based Primary Care (HBPC) • Homebound, VA primary care provided at home, geographically restricted areas • Homemaker/Home Health Care (H/HHA) • Very similar to IHSS • Purchased from community agencies • Contract Adult Day Care (CADHC) Note: VA largely blind to parallel services, such as IHSS

  11. Home Care Services • Purchased 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 program • Veteran Directed Care Unlike Medicare, all purchased VA home care prospectively authorized

  12. Nursing Home Care • VA Nursing Homes (Community Living Centers, CLCs) • Short-stay rehab/post hospital • Long term care for highly 60% + SC veterans • Community Nursing Home (CNH) program

  13. Challenges • Two-way lack of knowledge • Community organizations do not understand VA • Many VA providers equally ignorant of community resources • Common complaint about VA – don’t know who to talk with/ poor contact information.

  14. The Great Myth • Care of veterans the sole responsibility of the VA • Reality: 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

  15. Suggestions • Incorporate routine inquiry regarding veteran status into assessments • Assess enrollment status, service-connection • If enrolled – which VAMC • Become familiar with unique VA services and where VA can “plug holes”

  16. Special VA Services • Some Home Care Services • Spinal Cord Injury • Mental Health Services • PTSD, Substance abuse • Care for Homeless Veterans (residential programs, HUD/VASH (voucher) program • Hospice/palliative care • Blind rehabilitation programs

  17. Cultivate Your Contacts at Local VAMCs! • Admissions and Eligibility • Caregiver Support Program • Home Care • Geriatrics and Extended Care • Homeless Veteran Program Coordinators • Patient Advocate • Veteran Service Officers • ADRC points of contact Note: Quality of facility websites- variable. When in doubt, call program offices

  18. Summary • VA 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!

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