5California Veterans Of these… 2.2 Million (6%) of California populationOf these…94% men, 6 % women35% of veterans are > age 65 (10.6 % overall pop. > 65)21% of Californians > 65 are veterans> 60% of Californian men > 65 are veterans
6Think of the VA when…A veteran tells you that he/she is enrolled at a particular VA facilityFunding difficulties – ineligible for Medicare, MediCal and no private insuranceMilitary/Veteran-related issues arise
7Think of the VA when… Special clinical needs Concern about benefits Related to military serviceMental Health issues/PTSDNeeds adjunctive care to stay at homeHomelessnessBlindConcern about benefits
9VA FacilitiesHave discrete catchment areasAssociated Clinics (Community Based Outpatient Clinics – CBOCs)Veterans enrolled at a particular facilityEncouraged to have primary care providerVA Medical Centers function much like a managed care organization like Kaiser.
10EligibilityPrioritization of veterans with Service-Connected DisabilitiesDiffering eligibility standards for Outpatient/Home/Acute care and Nursing Home CareOutpatient/acute: basic eligibilityLong Term Nursing Home: highly SC only
11Is VA Care a Form of Insurance? Yes and NoYes: 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
12Example: Hospice Care VA Hospice Benefit – mimics Medicare Especially useful for veterans <65 without MedicareFor enrolled veterans as ordered by a VA providerNot intended for un-enrolled veterans calling a VA facility to get them to cover care
13Home Care Services Home-based Primary Care (HBPC) Homebound, VA primary care provided at home, geographically restricted areasHomemaker/Home Health Care (H/HHA)Very similar to IHSSPurchased from community agenciesContract Adult Day Care (CADHC)Note: VA largely blind to parallel services, such as IHSS
14Home 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 programVeteran Directed CareUnlike Medicare, all purchased VA home care prospectively authorized
15Nursing Home Care VA Nursing Homes (Community Living Centers, CLCs) Short-stay rehab/post hospitalLong term care for highly 60% + SC veteransCommunity Nursing Home (CNH) program
16Challenges Two-way lack of knowledge Community organizations do not understand VAMany VA providers equally ignorant of community resourcesCommon complaint about VA – don’t know who to talk with/ poor contact information.
17The Great Myth Care of veterans the sole responsibility of the VA Reality: only 26% of veterans cared for by VA in any given yearMany of these veterans receive only some of their care through VAGiven this, optimal care for veterans requires collaboration between VA and community organizations
18SuggestionsIncorporate routine inquiry regarding veteran status into assessmentsAssess enrollment status, service-connectionIf enrolled – which VAMCBecome familiar with unique VA services and where VA can “plug holes”
19Special VA Services Some Home Care Services Spinal Cord Injury Mental Health ServicesPTSD, Substance abuseCare for Homeless Veterans (residential programs, HUD/VASH (voucher) programHospice/palliative careBlind rehabilitation programs
20Cultivate Your Contacts at Local VAMCs! Admissions and EligibilityCaregiver Support ProgramHome CareGeriatrics and Extended CareHomeless Veteran Program CoordinatorsPatient AdvocateVeteran Service OfficersADRC points of contactNote: Quality of facility websites- variable. When in doubt, call program offices
21SummaryVA provides excellent healthcare – with some benefits not readily available through the communityNavigating the VA labyrinth can be challengingIt is all about relationships and communicationTogether, we can do a better job serving those who have served!