Transcript Slide 1
James Hallenbeck, MD
Associate Chief of Staff, Extended Care,
VA Palo Alto Health Care System,
Associate Professor, Stanford University
[email protected]
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
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
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
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.
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
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
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
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
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
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
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.
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
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”
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
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 websitesvariable. When in doubt, call
program offices
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!