New York & Veterans Directed Home and Community Based Services Program

1. New York & Veterans Directed Home and Community Based Services Program Philip McCallion & Lisa A. Ferretti, Center for Excellence in Aging Services www.albany.edu/aging Gail Koser & RinaKitazawa NY State Office for Aging

2. Background VDHCBS introduced as a new component of AoA’s 2008 Nursing Home Diversion Modernization Grant NYSOFA worked with VA and AAAs to submit an application for VDHCBS New York State – one of 10 states to be awarded the VDHCBS grant in September 08 New York also selected in 2009 for Community Living Program & VDHCBS

3. Program Goals To better serve veterans of all ages at risk of nursing home placement To encourage collaboration and partnerships between Aging and VA networks To reduce duplication of effort and resources To replicate and expand program in other areas of the State

4. Elements of VDHCBS Veterans Health Administration will purchase consumer directed and other home and community based services from the Aging Network for eligible veterans of all ages. Consumer directed personal care services a necessary component Provider agreement between the local VA Medical Center and counties/AAAs

5. Necessary Steps for VDHCBS • Development of consumer directed infrastructure • Completion & Review of Readiness Tool • Determination of services and rates • Review and signing of the Provider Agreement

9. VISN 2 Counties Selected for Veteran Directed Model 10/1/08 – 3/31/09 (FY-09) • Onondaga • Currently enrolled in Primary Care 6370 • Over 80 years old 1340 • Broome • Currently Enrolled in Primary Care 2678 • Over 80 years old 572 • Oneida • Currently Enrolled in Primary Care 3623 • Over 80 years old 659

10. VDHCBS Process VA MC identifies eligible veterans and refers them to the AAA. AAA contacts the veteran and completes an intake assessment. AAA develops a care plan and budget. VA MC authorizes the care plan and budget. AAA submits invoices to VA MC each month. VA MC provides payment to the AAA.

11. Challenges of VDHCBS VDHCBS is an evolving program. Consumer directed careneeds to be in place before proceeding with VDHCBS. Aging and VA networks must learn about each other’s systems, processes, and requirements. Aging network must learn to work with a new population with needs that may differ from older adult clients (e.g. veterans with TBI).

12. Specific Challenges • Using existing case managers versus designated care coordinators • Costing services • HIPPA • Start-up costs

13. The Process • Referral to VDHCBS: The VA Medical Center determines a veteran’s eligibility for VDHCBS and refers eligible veterans to the Area Agency on Aging. • Care plan:Veterans who choose VDHCBS work with a Care Coordinator or Case Manager at the Area Agency on Aging and any others whom the veteran chooses. These individuals help the veteran design a care plan that includes all the care and services needed. This group of people is called a care team. • Budget:Veterans have staff from an agency, called a fiscal intermediary, to help them manage a monthly budget. The amount of money in the monthly budget is based on the participant’s care plan.

14. Services • Personal care • Housekeeping • Chore and companion/supervision services • Social or medical adult day care • Home delivered meals • Congregate meals • Nutrition education • Nutrition counseling • Caregiver support including training, counseling, support groups and respite • Health promotion • Transportation

15. Goods • Appliances • Assistive devices/assistive technology Some at least will be funded through existing VHA programs

16. Opportunities Increased communication between the Aging and VA networks at local, State, federal level New and ongoing source of funding for AAAs Discussion of other partnership opportunities between Aging and VA Collaboration with other states