VA CAREGIVER PROGRAM AND OTHER SUPPORTIVE SERVICES

1. VA CAREGIVER PROGRAM AND OTHER SUPPORTIVE SERVICES Lisa Sweeney, LCSW Caregiver Support Coordinator Jessica Hollie, LICSW Contract Nursing Home Program Director Robyn Shafer, RN, BSW Hospice Coordinator August 15 2019

2. OBJECTIVES AND AGENDA • Overview of Department of Veteran Affairs • Overview of the Veterans Health Administration (VHA) • Review of the Minneapolis VA Caregiver Support Program • Review of Minneapolis VA Home and Community Care Services

3. DEPARTMENT OF VETERAN AFFAIRS (FEDERAL) Veterans Health Care Administration Delivery of Health Care Services through Medical Centers, Community Based Outpatient Clinics and Community Based Home Care Services Veterans Benefits Administration Compensation and Pension Veterans may be eligible for a service connection compensation if they have a disability related to their time in service Low-income Veterans may be eligible for a Pension Fiduciary Service National Cemetery Administration

4. VHA – VETERANS INTEGRATED SERVICE NETWORKS (VISN)

5. THE MINNEAPOLIS VA HEALTH CARE SYSTEM (VISN 23) • Services over 100,000 veterans • Includes specialties including: • Primary care • Mental Health • Specialty Care • Extended Care and Rehab • Polytrauma/TBI rehab • Spinal Cord Injury • Caregiver Program • Hospice • Behavioral Outreach Team

6. ELIGIBILITY • Veterans must be enrolled in their local VA in order to access VA Health Care Programs • Veterans need to have served in the active military, naval or air service and were separated under any reason other than dishonorable • Other considerations for eligibility: length of active duty time and income • Minneapolis VA Patient Access Center: 612-467-2071 • Enrollment requires the veteran to submit the 10-10EZ an a copy of their DD214 • All veterans are encouraged to apply! https://www.va.gov/vaforms/medical/pdf/1010ez-fillable.pdf

7. DEPARTMENT OF VETERAN AFFAIRS (STATE) • County Veteran Service Officers • Veteran advocates available at each county office to assist with access of care and benefits • State Veterans Homes • Every State has at least one veterans home • Available to Veterans and their spouses • Minnesota: • 5 Veterans Homes in MN • Adult Day Program (Mpls)

8. VA CAREGIVER SUPPORT PROGRAM

9. CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT OF 2010 (PUBLIC LAW 111-163) • Signed into law on May 5, 2010 • Requires the VA to establish a program of general caregiver support services. • Requires the VA to establish a Comprehensive Caregiver Program that provides enhanced benefits to eligible caregivers.

10. VA CAREGIVER SUPPORT PROGRAM • Community Outreach • Ongoing communication with community partners regarding caregiver services • Minneapolis VAMC Caregiver initiatives • Referral source/point of contact for all caregivers, and facilitator of caregiver programs & services within the facility • Comprehensive Caregiver Program • Development & oversight of program that provides enhanced benefits to eligible caregivers

11. VA CAREGIVER SUPPORT PROGRAM Program of General Caregiver Support Services (All Era Veterans) PROGRAM OF COMPREHENSIVE ASSISTANCE FOR FAMILY CAREGIVERS (CURRENTLYPOST 9/11/2001 VETERANS) Assistance Provided VA Supportive Services (HCC) Local VA & Community Support Groups & Programs VA Caregiver Program National Supportive Resources • Provides enhanced benefits and assistance to primary and secondary caregivers of seriously injured post 9/11 veterans

12. CAREGIVER SUPPORTIVE SERVICES & PROGRAMMING • Education and training • Support Groups • Lodging if Veteran present • Fisher Houses • Respite Care • In-Home Services • Adult Day Health Care Programs • Home Based Primary Care • Medical Foster Home Program • Telehealth • MyHealtheVET • Caregiver Information on VA Health Web site

13. Caregiver Support Services & Programming • National Programming • Caregiver Support Line Monthly Telephone Groups • Caregiver Peer Support Program • Building Better Caregivers On-Line Education Program • Self-Care Courses

14. Program of Comprehensive Assistance for Family Caregivers • Administrative Eligibility: • *currently A Veteran (or Servicemember undergoing medical discharge from the Armed Forces) who has a serious injury incurred or aggravated in the line of duty on or after September 11, 2001. • Clinical Eligibility: • The Veteran or Servicemember requires at a minimum six months of continuous and approved caregiver support, based on: • Inability to perform one or more Activities of Daily Living (or) • Need for Supervision, Protection, or Assistance in one area (relating to Traumatic Brain Injury, psychological trauma or other mental disorder).

15. PROGRAM OF COMPREHENSIVE ASSISTANCE FOR FAMILY CAREGIVERS Enhanced Benefits: Primary Caregiver • Caregiver stipend • Formalized training program • Validation of competencies • Ongoing monitoring • Health care coverage • Mental health services • Travel, lodging, & per diem reimbursement for training and for veteran hospital stays/appointments Additional Family Caregivers • Formalized training • Mental health services • Travel, lodging, & per diem reimbursement for training and for veteran hospital stays/appointments

16. HOW TO APPLY(PROGRAM OF COMPREHENSIVE ASSISTANCE FOR FAMILY CAREGIVERS) • Application form is identified as 1010CG • Can access application on the VA Caregiver Website • www.caregiver.va.gov • Can also contact the VA Caregiver Support Line • 1-855-260-3274 • Contact the Caregiver Support Coordinator at your local VA Medical Center

17. NATIONAL VA CAREGIVER SUPPORT PROGRAM National Statistics: 118,000+ Stipend Program Applications Filed 38,000+ Stipend Program approved 385,000+ Caregiver Support Line calls (rolled-out February 2011)

18. VA MISSION ACT 2018 • Signed Into Law on June 6, 2018 • Allowed for Expansion of Program of Comprehensive Assistance for Family Caregivers to All Era Veterans • Implementation Phase is Currently In-Process • The expansion will occur in two phases beginning with eligible Veterans who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975, with further expansion to Veterans of all eras beginning two years later.

19. VA CAREGIVER SUPPORT PROGRAM NATIONAL ACCESS POINTS • VA Caregiver Website • www.caregiver.va.gov • VA Caregiver Support Line • 1-855-260-3274

20. VA HOME AND COMMUNITY CARE PROGRAMS AND SERVICES

21. VA HOME AND COMMUNITY CARE PROGRAMS • Home-Based Primary Care • Medical Foster Home • Adult Day Care • Contract Nursing Home • Community Adult Day Care • Home Health Care Services • Respite Care • Home Hospice Care

22. HOME-BASED PRIMARY CARE (HBPC) • Full interdisciplinary team: nurse, physician, nurse practitioner, social worker, rehabilitation therapist, dietitian, pharmacist, psychologist • Targets patients with complex, chronic, disabling disease when routine clinic-based care is not effective • Requires frequent follow-up in order to manage their medical condition.

23. MEDICAL FOSTER HOME • Community caregiver welcomes dependent veteran into their private home • MFH caregiver provides daily personal assistance, supervision, medications, meals, recreation etc. • VA HBPC provides comprehensive medical care and management; caregiver education/support • Funding – private pay, medical assistance waiver (typically cost between $3,000-$5,000 a month)

24. VA ADULT DAY HEALTH CARE (ADHC) • Enable frail elderly and functionally impaired veterans to remain in supportive home environments • Improve quality of life by maximizing the veteran’s physical, cognitive, and psychosocial function • Provide support, education, and respite for the family and other primary caregivers

25. VA PAID HOMECARE • Home care provided by agencies in the community • Skilled Nursing: • Clinical need • Home Health Aide: • Assistance with personal cares • Homemaking (light housekeeping) services are also available as part of other homecare services • Enable frail or disabled veterans to live at home.

26. HOME HOSPICE CARE • The primary goal of hospice and palliative care is comfort rather than cure for patients with advanced disease that is life-limiting and unresponsive to disease-modifying treatment • Hospice and palliative care services will include bereavement support to the veteran’s family. • Coordinated by the VA utilizing community based hospice agencies (80-100 available)

27. VA PAID RESPITE • Respite benefit includes 30 total days of respite care per calendar year. May use one type, or a combination of the following types, of respite to reach the maximum 30 days: • In-home (not to exceed 6 hours per episode of care) • Contract Nursing Home (1 calendar day) • Adult Day Health Care (ADHC)-up to 6hrs

28. CONTRACT NURSING HOME AUTHORIZATIONS • Millennium Bill: • 70% SC or higher, 60% and unemployable or NH care is related to SC disability (approved by MD) • Hospice • Enrolled in the Minneapolis VA and with a Medicare Certified hospice agency • Respite: • Must have Primary Care at the VA and a live in caregiver • Enrolled at the Minneapolis VA

29. OTHER VA PROGRAMS • The Minneapolis VA Health Care System attempts to utilize internal VA resources when available. For example: • VA Community Living Center – for sub-acute rehab or hospice • VA Acute Rehab Units – traumatic brain injury, stroke, spinal cord injury • Call the referral number: 612.467.2019 for these programs • St. Cloud VA Community Living Center - for long-term care or behavior care

30. NATIONAL VHA POINTS OF CONTACT • Veterans Crisis Line: • 1-800-273-TALK(1-800-273-8255) • Health Care Benefits: • 1-877-222-8387 • Vets.gov Help Desk • 1-855-574-7286 • Women Veterans Hotline • 1-855-VA-WOMEN (1-855-829-6636)

31. THANK YOU!QUESTIONS?