A Quick Primer on “the VA”for ADRCs
James Hallenbeck, MDAssociate Chief of Staff, Extended Care, VA Palo Alto Health Care
System,Associate Professor, Stanford University
Anita Shumaker, C.A.,C.M.T.,C.M.P.California Department of Veterans Affairs
California Veterans2.2 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
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
A Deeper Dive into VHA
VA FacilitiesHave discrete catchment areasAssociated 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.
EligibilityPrioritization 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
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 CareVA Hospice Benefit – mimics MedicareEspecially 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
Home Care ServicesHome-based Primary Care (HBPC)
Homebound, VA primary care provided at home, geographically restricted areas
Homemaker/Home Health Care (H/HHA)Very similar to IHSSPurchased from community agencies
Contract Adult Day Care (CADHC)
Note: VA largely blind to parallel services, such as IHSS
Home Care ServicesPurchased 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 Care
Unlike Medicare, all purchased VA home care prospectively authorized
Nursing Home CareVA Nursing Homes (Community Living
Centers, CLCs)Short-stay rehab/post hospitalLong term care for highly 60% + SC veterans
Community Nursing Home (CNH) program
CalVet State HomesCalifornia Department of Veterans Affairs8 Homes in the state with multiple levels of care
Redding Yountville Fresno Ventura West Los Angeles Barstow Lancaster San Diego
CalVet State HomesOpen to Veterans and Non Veteran Spouses
Independent Living (Domiciliary)
Assisted Living (Residential Care for the Elderly RCFE)
Intermediate Nursing Care (Intermediate Care Facility)
Skilled Nursing Facility Care/Memory Care (SNF)
CalVet State Homes Independent Living (Domiciliary)
Ability to perform activities of daily livingNon nursing staff supervision
Assisted Living (RCFE)Minimal assistance with activities of daily
livingLicensed nursing staff supervision Memory care program (mild to moderate
Symptoms)
CalVet State HomesIntermediate Nursing Care (Intermediate Care
Facility)Licensed nursing staff supervisionNon nursing staff assistance with activities of daily living
Skilled Nursing Care/Skilled Nursing (memory care)
24 hour services of licensed nursesRehabilitation therapiesActivitiesDietary
CalVet State HomesOnsite outpatient clinics
Providing Primary CareProviding routine health care
services
Multi-disciplinary Coordinating services with specialists
CalVet State HomesMaintains transfer’s between level of care
changes
Short Term Skilled Nursing Facility Care
Long Term Skilled Nursing Facility Care
Hospice Care
CalVet State HomesCommunity Living
MealsSocial ActivitiesOrganized Community EventsOnsite Therapeutic ClassesHealth EducationBarberFitness CenterBowling AlleyArts and CraftsLibrariesChapelsStore
CalVet State HomesThe Pathway Home Program
Residential Recovery program
Serving our nations “New Warriors”Nations Global War on TerrorAfghanistan and IraqPost deployment
www.thepathwayhome.org
CalVet State HomesCommunity Living
MealsSocial ActivitiesOrganized Community EventsOnsite Therapeutic ClassesHealth EducationBarberFitness CenterBowling AlleyArts and CraftsLibrariesChapelsStore
www.calvet.ca.gov
ChallengesTwo-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 MythCare of veterans the sole responsibility of the
VAReality: 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
SuggestionsIncorporate routine inquiry regarding
veteran status into assessmentsAssess enrollment status, service-connectionIf enrolled – which VAMC
Become familiar with unique VA services and where VA can “plug holes”
Special VA ServicesSome Home Care ServicesSpinal Cord InjuryMental Health Services
PTSD, Substance abuseCare for Homeless Veterans (residential
programs, HUD/VASH (voucher) programHospice/palliative careBlind rehabilitation programs
Cultivate Your Contacts at Local VAMCs!Admissions and EligibilityCaregiver Support ProgramHome CareGeriatrics and Extended CareHomeless Veteran Program CoordinatorsPatient AdvocateVeteran Service OfficersADRC points of contact
Note: Quality of facility websites- variable. When in doubt, call
program offices
SummaryVA 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!