ODDC- DVA - Delivering on the Promise

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TITLE: Delivering on the Promise: U.S. Department of Veterans’ Affairs Self-Evaluation to Promote Community Living for People with Disabilities

AUTHOR: Specific author unknown (KACW 3/20/03)

KATHY’S NOTE: The report was full of out-dated and very confining language that makes me question what the Department’s philosophy on community integration really is.

VETERANS’ BENEFITS ADMINISTRATION:The Veterans Benefits Administration (VBA) provides disability compensation and pension to more than 2.7 million veterans each year. Disability compensation is a monetary benefit paid to veterans with service-connected disabilities. "Service connected" means that the disability was a result of disease or injury incurred or aggravated in line of duty. Disability compensation is graduated according to the degree of the veteran’s disability. Veterans with nonservice-connected disabilities also may be eligible for VA pension programs. Pensions may also be paid to the survivors of wartime veterans. In 2001, VBA estimates paying $22 billion in disability compensation, survivor benefits and disability pension to 3.2 million people. VBA also offers programs to support the needs of disabled veterans allowing millions to live independently, including:

Vocational Rehabilitation and Employment (VR&E) Program provides comprehensive services enabling veterans with service-connected disabilities to become employable, and obtain and maintain stable, suitable employment. When the veteran cannot work, the program offers assistance to achieve maximum independence in daily living. Program services may include evaluation of rehabilitation needs, employment services, medical and dental care, financial counseling, and where needed, education or training to develop marketable job skills. Veterans may also receive a subsistence allowance for education and training. Certain dependent children with spina bifida may receive education and training benefits if the spina bifida is the result of a parent’s active service in Vietnam.
Aid and Attendance Services offer disabled veterans receiving service-connected compensation or a non-service disability pension and need attendance services, additional monetary compensation or pension to pay for these services.
Veterans who are permanently and severely disabled due to service-related conditions are eligible for a grant of up to $43,000 to purchase or remodel a home to make it accessible.
Veterans who have, through their service, lost hands, feet or vision may be eligible for $8,000 toward the purchase of a specially-adapted automobile.
Veterans who have service-connected disabilities requiring use of prosthetic or orthopedic appliances that wear out or tear clothing are eligible to receive annual clothing allowances.

Eliminated Barriers: VR&E has begun new initiatives to reduce or eliminate barriers by identifying needed vocational rehabilitation services, delivering needed services, and breaking down employment barriers experienced by people with disabilities. Examples of barriers that have been eliminated include:

Partnering with the Department of Defense to streamline the claims process by conducting one physical examination for all military personnel when they leave active duty to serve as both the military separation physical and the VA compensation physical allowing claims for VA service-connected disabilities to be processed more quickly.
Relocating VR&E staff to be closer to the veteran population and using contract service providers to augment VR&E staff.
Using portable computer and video teleconferencing tools to allow case managers to do their jobs virtually anywhere.
Using "distance learning," such as the Internet, as avenues for training and employment that has not been previously available.

The vocational rehabilitation and employment for service-disabled veterans is a job-focused program to help eligible, service-disabled veterans obtain and maintain suitable employment. In some cases, the veteran is assisted in choosing an occupation and an Individualized Written Rehabilitation Plan (IWRP) of services is developed. Necessary services often include training or education, and VR&E provides for all authorized expenses of school, including tuition, books, and fees. VR&E has participated in the Disabled Transition Assistance Program (TAP) briefings and the Employment Specialist Pilot Program working with employers on the advantages of hiring vocational rehabilitation graduates. The VR&E Service has facilitated case management by developing a state-of-the-art electronic case management system that tracks the veteran’s progress and authorizes required tuition, books, fees, supplies and equipment.

Remaining Barriers: To reduce the backlog of 661,000 claims for 2.7 million veterans and survivors, the Secretary established a team at the Cleveland VBA Regional Office that will focus initially on the longest pending claims and the claims of the oldest veterans. The Secretary has also instructed the Veterans Health Administration (VHA) to work in cooperation with VBA to quickly schedule and complete physical and psychological examinations as part of the compensation and claims process.

VETERANS HEALTH ADMINISTRATION: The Veterans Health Administration’s (VHA) primary objective is to achieve the maximum independence for veterans by providing rehabilitative services or independent living skills. Beginning in 1995, VHA began a fundamental transformation, developing into the largest integrated health care system in the Nation. Inpatient wards were closed as care shifted to ambulatory settings and primary care models. The VA has eliminated more than 6,000 inpatient beds and established over 2,000 psychosocial residential rehabilitation beds. The bulk of care was provided in outpatient clinics, and VA began to expand home-based services. The VHA provides the following services:

Primary health care,
Health education and training classes,
Surgical procedures,
Inpatient and outpatient mental health and substance abuse treatment services,
Home health care services including respite, hospice care and palliative care,
Urgent and limited emergency care services, and
Drugs, pharmaceuticals and supplies.

The VHA also provide the following specialty services:

Spinal Cord Injury and Disorders Treatment including acute inpatient, rehabilitation, outpatient, and home-based care as well as annual health examinations and all medically necessary equipment and supplies.
The Blind Rehabilitation Service enhances the quality of life for eligible visually impaired veterans through identification, treatment, education and research programs.
Traumatic Brain Injury (TBI) services include evaluation and referral to a VHA TBI center, which provide comprehensive assessment, acute rehabilitation and neurobehavioral management, outpatient services, referrals for community-based support care and equipment and supplies. There are four VHA TBI centers, 22 supporting network centers and 26 TBI coordinators who facilitate referrals and coordination of services.
Mental Health services include acute inpatient, outpatient, rehabilitation and residential mental health treatment.
VA staff conducts outreach to area homeless shelters, network with community agencies to facilitate referral of veterans to VA facilities, and organize annual stand-down events across the country. VA also assists homeless veterans with accessing medical and other VA benefits and services.

The Department also provides home and community services by partnering with other agencies such as: nursing home and nursing care services, community-based services, adult day care, respite and hospice services, residential programs, homeless programs, treatment programs; home improvement and modification programs, transportation programs, work programs, and durable medical equipment.

ELIMINATED BARRIERS: The VA has reduced admissions and lengths of stay in inpatient facilities by: opening community-based outpatient clinics serving more veterans closer to home at less cost; primary care and case management have reduced unnecessary admissions; ambulatory surgery and providing the equipment; community-based services and medications to allow veterans who live in long term care settings to reside in a less restrictive environment. VHA’s ability to provide or pay for homemaker, respite and adult day care services has allowed veterans to remain in their homes rather than be placed in institutions. Mental Health Intensive Case Management Programs are designed to help veterans who are frequently admitted or who are frequent walk-in patients live more successfully in the community.

The passage of the Veterans Health Care Eligibility Reform Act of 1996:

VHA facilities no longer have to admit veterans to make them eligible for outpatient care and medical and prosthetic equipment.
Clarifies VA’s authority to furnish preventive services to nonservice-connected veterans without receiving inpatient treatment first
Requires VA to establish an Annual Patient Enrollment System by establishing seven enrollment categories, based on special disability groups and income.
Requires VA to maintain its capacity in special emphasis programs. VHA identified twelve special emphasis programs: blind rehabilitation, geriatrics and long-term care, homelessness, Persian Gulf Veterans programs, post-traumatic stress disorder, preservation amputation care and treatment, prosthetics, readjustment counseling services, seriously mentally ill, spinal cord injury and disorders, substance abuse treatment, and women veterans programs.
Authorizes VA to contract with community providers for the sharing of health care services.

The passage of Veterans Millennium Health Care and Benefits Act of 2001:

Requires VA to provide or pay for nursing home care for veterans who are rated 70 percent or more disabled and those needing nursing home care for a service-connected condition.
Requires VA to provide an extended care benefits package that includes both institutional and non-institutional benefits, such as adult day health care, community nursing home care, geriatric evaluation and respite care.
Requires VA to provide alternatives to institutional care for elderly and disabled veterans.
Changed the previous six-month limitation on adult day health care services for some disabled veterans to an indefinite benefit based on the needs of the veteran.
Requires VA to maintain the level of services and staffing in long-term care programs provided nationally in VHA facilities during Fiscal Year 1998.
Authorizes VA to fund pilot programs to provide all-inclusive care for elderly veterans.
Authorizes VA to fund a pilot program to provide assisted living services.
Establishes a special eligibility category for VA health care for veterans awarded the Purple Heart.

The Veterans Benefits and Health Care Improvement Act:

Authorizes VA to provide temporary lodging services for veterans and those providing family support giving VHA statutory authority to provide or to pay for temporary lodging for veterans living too far to commute to the closest VHA facility for outpatient care and procedures.
Authorizes VA to accept, maintain and operate Fisher Houses, donated to the Department by the Fisher House Foundation to temporarily lodge family members of hospitalized veterans.

REMAINING BARRIERS:

Transportation to VHA facilities continues to be problematic in rural parts of the country, despite the Disabled American Veterans transportation network.
As seriously mentally ill veterans age, they can develop health care problems associated with old age and need specially structured environments and services to assure their health, safety and well-being.
Some VHA community-based outpatient clinics (CBOCs) do not offer basic mental health services. Recently the Assistant Deputy Under Secretary for Health has required that all facilities submit plans for the provision of mental health services to veterans receiving care in CBOCs in fiscal year 2002.

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