Home Health Options in the VA

Home Based Primary Care In place of a clinic visit to a primary care physician (will describe LR model) Interdisciplinary in nature Joint Commission accredited

Patient Characteristics (1) Homebound Frail with chronic medical problems Accepting of care Generally geriatric

Patient Characteristics (2) Avg age is 80 Medical problems avg 12-20 Cognitive Impairment of some degree is prevalent If spouse is caregiver, also frail with cognitive impairment Avg income $20,000 Youngest patient 23---oldest 102 As many as 30 problems

Patient “Qualifications” Meet the characteristics Live in geographic territory Don’t drive Have a caregiver Have a habitable home Safe environment---substance abuse, violent neighborhood

Refferals Formal consults Informal consults Inferred through other needs Self referrals Other patients/caregivers refer

Process Evaluation---SW, Psychologist, APN Needs can be met by team resources Patient agrees to limit outside providers All team members assess the patient Treatment Plan is developed in an interdisciplinary team meeting

VA Health Care Team APN RN SW Psychologist Therapist RD Pharmacist Medical Support Clerk Physician PATIENT/CAREGIVER

Medical Foster Homes Piloted in Little Rock---Judy Karklins, LCSW Adopted as national program Patients must be followed by HBPC Veteran pays for room/board/physical care on a scale according to ADL needs VA vets the homes for safety/suitability

MFH (2) Non-institutional care “Age In Place” Family atmosphere Sufficient Income Same criteria as for HBPC Based on Medicaid Waiver program of Oregon to try and decrease NH placements. Not as regulated as ours---no asso health care team. Money to pay is most often from getting Veteran benefits from filing for pensions---can be private pay Problems occur when only source of income for the caregivers/sponsors. Back ground checks.

Fee Services Home Health Aides Skilled Nursing Service Hospice Therapy

Process for Fee Service Order Alert to Community Health Division of HHCS CHN contacts Fee Office for fee payment approval Fee physician approval of care CHN locates agency in Veteran’s area who has availability and faxes orders, pertinent clinical data and fee authorization for payment to agency