Establishing a Person-Centered Culture in a VA Nursing Home

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by JOHN DAVY

The Veterans Administration has taken up the model of person-centered care, asking administrators throughout its health care system to modify their facilities and train their staff accordingly. Staff from the VA’s newly-renamed Haley’s Cove Community Living Center (HCCLC) in Tampa, Florida recently published a case study on their own shift to the patient-centered model.

HCCLC assigned an ethics committee responsible for providing oversight and education on patient autonomy, and which reviews ethical issues that arise in providing care. The case study provides examples, including a resident asking to stay outside on the patio on sleepless nights. The case study presents how the committee and staff established a plan to encourage the resident’s autonomy without putting him or other residents at risk. Other examples include allowing residents more choice in diet and dining, and providing support for residents who want to dine out.
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DOD AND VA HEALTH CARE Federal Recovery Coordination Program Continues to Expand but Faces Significant Challenges

Why GAO Did This Study

In 2007, following reports of poor case management for outpatients at Walter Reed Army Medical Center, the Departments of Defense (DOD) and Veterans Affairs (VA) jointly developed the Federal Recovery Coordination Program (FRCP) to coordinate the clinical and nonclinical services needed by severely wounded, ill, and injured servicemembers and veterans. The FRCP, which continues to expand, is administered by VA, and the care coordinators, called Federal Recovery Coordinators (FRC), are VA employees. This report examines

(1) whether servicemembers and veterans who need FRCP services are being identified and enrolled in the program,

(2) staffing challenges confronting the FRCP, and

(3) challenges facing the FRCP in its efforts to coordinate care for enrollees.

GAO reviewed FRCP policies and procedures and conducted over 170 interviews of FRCP officials, FRCs, headquarters officials and staff of DOD and VA case management programs, and staff at medical facilities where FRCs are located.

What GAO Recommends

GAO recommends that VA direct the FRCP Executive Director to establish systematic oversight of enrollment decisions, complete development of a workload assessment tool, document staffing decisions, and develop and document a rationale for FRC placement. GAO received comments from DOD and VA; VA concurred with GAO’s recommendations.

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Updated: Procedures for Implementing Veteran Directed Home and Community Based Services

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The VD-HCBS program provides veterans the opportunity to receive home and community-based services that enable them to avoid institutionalization and continue to live in their homes and communities. The Procedures for Implementing Veteran Directed Home and Community-Based Services describes requirements and procedures for implementing VD-HCBS locally.

VA Caregiver Support Line

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On February 1, 2011, the Department of Veterans Affairs (VA) opened a toll-free National Caregiver Support Line.  The support line serves as a primary resource/referral center to assist caregivers, Veterans and others seeking caregiver information to help in the care of our Nation's Veterans.

Calls to The National Caregiver Support Line will be answered by VA employees who are licensed clinical social workers.

The Support Line provides information on VA/ community caregiver support resources and "warm" referral to dedicated Caregiver Support Coordinators located in every VA Medical Center; emotional support for the caregiver is an integral component of this service. The National Caregiver Support Line is also available to respond to inquiries about the caregiver benefits associated with Public Law 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010.

The National Caregiver Support Line will be open Monday through Friday 8:00 a.m. to 11:00 p.m. and Saturday 10:30 a.m. to 6:00 p.m. Eastern Time, the Toll-Free number is 1-855-260-3274.

You can also visit the VA's updated VA Caregiver Support: Caring for those Who Care Website

More Vets Approved for Agent Orange Claims from MedPage Today

By Joyce Frieden, News Editor, MedPage  Today

Veterans who served in Korea from 1968 through 1971 were probably exposed to Agent Orange, which makes them eligible for treatment at VA medical centers, according to a ruling from the Department of Veterans Affairs.
"VA's primary mission is to be an advocate for veterans," Secretary of Veterans Affairs Eric K. Shinseki said in a statement. "With this new regulation VA has cleared a path for more veterans who served in the demilitarized zone in Korea to receive access to our quality healthcare and disability benefits for exposure to Agent Orange."


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More Veterans To Receive Options for Living Independently Under New VHA Partnership with National Resource Center for Participant-Directed Services - RWJF

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Veterans of all ages with disabilities will gain additional support in 28 states under a new program designed to help them live independently, with more choice and control over the services they receive in their homes. Through a contract with the Veterans Health Administration (VHA), the National Resource Center for Participant-Directed Services (NRCPDS) will provide training and assistance to VA Medical Centers that are implementing participant-directed services for Veterans.

In 2008, the U.S. Administration on Aging’s Community Living Program partnered with VHA to create the Veteran Directed Home and Community-Based Services (VD-HCBS) Program. The Program allows Veterans of all ages to have more control over services provided in their homes to allow them to continue to live independently in their communities. Veterans enrolled in the program can manage their own flexible spending budgets, decide for themselves what mix of goods and services can best meet their needs, hire and supervise their own workers, including family and friends, and purchase items or services that help them live more independently. We call this approach "participant direction."

The NRCPDS at Boston College is the only national center of its kind that helps people of all ages and disabilities get the support they need to live as independently as possible. The Center provides research, policy, training and assistance for participant-directed programs. In addition, NRCPDS has a National Participant Network that works with these programs to ensure that they are designed and implemented with the needs and preferences of the individual at their core. The Center will offer a wide variety of training and technical assistance to staff at VA Medical Centers for the benefit of Veterans in the VD-HCBS Programs.

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H.R. 168: To direct the Secretary of Veterans Affairs to improve the prevention, diagnosis, and treatment... (GovTrack.us)

To direct the Secretary of Veterans Affairs to improve the prevention, diagnosis, and treatment of veterans with chronic obstructive pulmonary disease.

Sponsor:	Rep. Clifford Stearns [R-FL6]hide cosponsors Cosponsors: John Lewis [D-GA5]
Text:	The text of this legislation is not yet available on GovTrack. It may not have been made available by the Government Printing Office yet.
Status:	Introduced Jan 5, 2011 Referred to Committee View Committee Assignments Reported by Committee ... House Vote ... Senate Vote ... Signed by President ... This bill is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee. [Last Updated: Jan 8, 2011 6:17AM]
Last Action:	Jan 5, 2011: Referred to the House Committee on Veterans' Affairs.

Current Status

Calling All Businesses – Hire More Veterans with Disabilities - Disability.gov

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By Guest Blogger Bill Lawson (U.S. Army, Ret.), National President of Paralyzed Veterans of America

Most people would agree that America’s Veterans with disabilities – those who have served and sacrificed for our freedoms – clearly deserve a fair shot at what is at the heart of the American dream, a good job with a good company.

Yet as we mark National Disability Employment Awareness Month, the unemployment statistic for Veterans with severe disabilities is a startling 85 percent.

How can we work together to change this picture and to turn this grim statistic around? How can we bring the collective power of the public and private sectors together to improve the quality of paralyzed Veterans’ lives while also improving business’ bottom line?

At Paralyzed Veterans of America (http://www.pva.org/), we decided to meet this challenge head on through our Mission: ABLE initiative (www.mission-able.com) – helping those who wore the uniform and were seriously injured get good jobs and careers.

We invested in a vocational rehabilitation program, designed to empower Veterans with disabilities with the services and tools they need to reintegrate into the job market – while matching them with businesses and organizations with career positions.

The program – with offices in Richmond, VA; Minneapolis, MN; San Antonio, TX; Long Beach, CA and Boston, MA – was established through an innovative public-private partnership between Paralyzed Veterans of America, businesses and the U.S. Department of Veterans Affairs (VA). In fact, our sixth office will open its doors, at no cost to tax payers, just after Veterans Day next month and is based at the Charlie Norwood VA Medical Center in Augusta, Georgia.

We have helped hundreds of Veterans with disabilities through this program and have developed working relationships with more than 300 employers. Of those helped, 120 have already obtained new careers with numerous employers. 63 program clients are Veterans of Afghanistan and Iraq.

There are three elements that work to make the Mission: ABLE initiative a success: connecting with Veterans, connecting with businesses and changing perceptions.

The program receives clients in a number of ways, from visiting newly injured patients to word of mouth. But the most important thing is that the program proactively reaches out to the Veterans, often meeting them early in the rehabilitation process, engaging patients, their families and outpatients alike and publicizing the program at events and in the media. With our offices located in VA spinal cord injury (SCI) centers, we maximize vocational rehabilitation exposure to the SCI Veterans and service providers.

Our voc rehab counselors network with Chambers of Commerce, community organizations (such as Rotary), job fairs and Veterans employment coordinators. They attend meetings and reach out to local and national employers to develop a network of business leaders who want to hire America’s Veterans.

For Veterans with disabilities, career opportunities can change their expectations of what comes next for them. With encouragement and help, they feel empowered to take the rights steps to finding a good job and fulfilling career.

For businesses, Veterans make great employees. They are disciplined, focused, reliable, hard working, team players and much more. In addition to working with Veterans, Mission: ABLE initiative staff members also spend time educating employers on working with people with disabilities. We complete a work assessment of the position to ensure we provide a good fit for the employer. We also provide information on tax and other incentives that vary by state for hiring people with disabilities. Plus, the program is recognized as an approved “employer network” (EN) by the Social Security Administration.

The truth is, hiring more Veterans with disabilities is a win, win for our country. Those who served secure good careers; employers get great employees; and, in turn, our economy becomes stronger.
It’s a strategy that helps empower America’s best with everything they need to live full, self-sufficient and productive lives. It’s a strategy that’s good for business and great for our nation.

Employers: America needs you to hire more paralyzed and disabled Veterans!

Bill Lawson (U.S. Army, Ret.) of Woodward, Oklahoma was elected National President of Paralyzed Veterans of America at its 64th Annual Convention in August. He is a staunch advocate for Veterans and people with disabilities.

Posted by Diana Z. on Oct 27, 2010 12:09:01 PM in Employment, Guest Blogger, Veterans & Military

Calling All Businesses – Hire More Veterans with Disabilities - Disability.gov

Better OR Teamwork Cuts Mortality Rates

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Loan Guaranty: Assistance to Eligible Individuals in Acquiring Specially Adapted Housing

Image via WikipediaVeterans and servicemembers with severe disabilities may be eligible under 38 U.S.C. chapter 21 for specially adapted housing (SAH) grants. In administering the SAH program, VA helps these eligible individuals to purchase, construct, or adapt a home that suits the individual's living needs. In a document published in the Federal Register on October 5, 2009 (74 FR 51103), VA proposed to amend regulations in 38 CFR part 36, subpart C, regarding assistance to certain disabled veterans in acquiring SAH, specifically Sec. Sec. 36.4400 through 36.4410, which implement the SAH grant program.

As explained in the proposed rule, VA is amending these regulations for three reasons.

• First, VA believes the regulations should be written in a reader-focused style. 
• Second, detailed guidance about program policies and a regulation written with an easy-to-follow organizational structure will help applicants and eligible individuals (and those acting on their behalf) understand program requirements.
• Third, substantive changes are necessary to implement recent legislation, policy decisions, and a VA General Counsel legal opinion. 

Pursuant to 38 U.S.C. 2101(d), the Secretary may prescribe regulations applicable to the SAH program. In revising these regulations, VA intends that applicants, eligible individuals, program participants, and other interested parties will be better informed about the legal requirements and Department policies that guide the administration of SAH grants.

Final Rule

U.S. Department of Veterans Affairs (VA) Publishes Final Rule to Help Veterans Exposed to Agent Orange - Disability.gov

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Veterans exposed to herbicides while serving in Vietnam and other areas will find it easier to access quality health care and qualify for disability compensation under a final rule published in the Federal Register. The new rule expands the list of health problems VA will presume to be related to Agent Orange and other herbicide exposures, which will speed up the application process. VA is adding Parkinson’s disease and ischemic heart disease and expanding chronic lymphocytic leukemia to include all chronic B cell leukemias, such as hairy cell leukemia.

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• Diabetes now Vietnam vets' top Agent Orange claim (sfgate.com)

Proposed Rulemaking: Garnishment of Accounts Containing Federal Benefit Payments

SUMMARY: Treasury, SSA, VA, RRB and OPM (Agencies) are publishing for comment a proposed rule to implement statutory restrictions on the garnishment of Federal benefit payments. The Agencies are taking this action in response to recent developments in technology and debt collection practices that have led to an increase in the freezing of accounts containing Federal benefit payments. The proposed rule would establish procedures that financial institutions must follow when a garnishment order is received for an account into which Federal benefit payments have been directly deposited. The proposed rule would require financial institutions that receive a garnishment order for an account to determine whether any Federal benefit payments were deposited to the account within 60 calendar days prior to receipt of the order and, if so, would require the financial institution to ensure that the account holder has access to an amount equal to the sum of such payments in the account or to the current balance of the account, whichever is lower.

DATES: Comments must be received on or before June 18, 2010.
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IT Saves $3 Billion in VA Health System from MedPage Today

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By John Gever, Senior Editor, MedPage Today

The Department of Veterans Affairs' long-term investment in healthcare information technology paid off at a rate of more than $500 million in net annual benefits from 2001 to 2007, researchers said.

That added up to more than $3 billion in benefits for the Department of Veterans Affairs (VA) during the study period, after an initial billion-dollar loss.

In particular, the department's computerized patient record system "was the dominant contributor to both benefits and costs in our analysis," wrote Colene M. Byrne, PhD, and colleagues at the Center for Information Technology Leadership in Charlestown, Mass., in the April issue of Health Affairs.
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• Study: VA's Computer Systems Cost Billions, but Have Big Payback (blogs.wsj.com)

Final Rule: Grants to States for Construction or Acquisition of State Home Facilities--Update of Authorized Beds

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This document adopts as a final rule the proposed rule to amend Department of Veterans Affairs (VA) regulations regarding grants to States for construction or acquisition of State homes. This final rule updates the maximum number of nursing home and domiciliary beds designated for each State and amends the definition of ``State'' for purposes of these grants to include Guam, the Northern Mariana Islands, and American Samoa. Effective Date: This final rule is effective May 10, 2010. Additional Information

Veterans Affairs: Diseases Associated With Exposure to Certain Herbicide Agents

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Proposed Rule

The Department of Veterans Affairs (VA) is proposing to amend its adjudication regulations concerning presumptive service connection for certain diseases based upon the most recent National Academy of Sciences (NAS) Institute of Medicine committee report, Veterans and Agent Orange: Update 2008 (Update 2008). This proposed amendment is necessary to implement a decision of the Secretary of Veterans Affairs that there is a positive association between exposure to herbicides and the subsequent development of hairy cell leukemia and other chronic B- cell leukemias, Parkinson's disease, and ischemic heart disease. The intended effect of this proposed amendment is to establish presumptive service connection for these diseases based on herbicide exposure.

DATES: Comments must be received by VA on or before April 26, 2010.

THE FIRST ANNUAL “EXCELLENCE IN ACTION” AWARDS

On Tuesday, February 23, 2010, the Administration on Aging held its first annual Excellence in Action Awards program to formally acknowledge exceptional work performed during the past year by Aging and Disability Resource Centers (ADRCs), Community Living Programs (CLPs), and Veteran-Directed Home and Community-Based Services programs. The awards were presented at the Administration on Aging/Centers for Medicare & Medicaid Service (CMS) 2010 National Grantee Conference entitled “Changing Systems, Changing Lives.”

Eligible nominees were State Units on Aging (SUAs), Area Agencies on Aging (AAA), Centers for Independent Living (CILs), State Independent Living Councils (SILC), Aging Disability Resource Centers (ADRC), Community Living Programs (CLP) and their partners or networks of these programs. Winners demonstrated exceptional commitment, creativity, leadership and success in achieving goals related to the conference theme.” Awards were given in the following categories:
•Changing Systems Award
•Changing Lives Award
•Exemplary Partnership Award

The 2010 Excellence in Action awardees:

Changing Systems Award - Agency on Aging of South Central Connecticut, New Haven, Connecticut

Changing Lives Award - Central Texas AAA/ADRC & Alamo Service Connection/Bexar Area Agency on Aging

Exemplary Partnership Award - Hawaii County Office on Aging, Hilo, Hawaii

Description of Each Award and Awardee

THE FIRST ANNUAL “EXCELLENCE IN ACTION” AWARDS

On Tuesday, February 23, 2010, the Administration on Aging held its first annual Excellence in Action Awards program to formally acknowledge exceptional work performed during the past year by Aging and Disability Resource Centers (ADRCs), Community Living Programs (CLPs), and Veteran-Directed Home and Community-Based Services programs. The awards were presented at the Administration on Aging/Centers for Medicare & Medicaid Service (CMS) 2010 National Grantee Conference entitled “Changing Systems, Changing Lives.”

Eligible nominees were State Units on Aging (SUAs), Area Agencies on Aging (AAA), Centers for Independent Living (CILs), State Independent Living Councils (SILC), Aging Disability Resource Centers (ADRC), Community Living Programs (CLP) and their partners or networks of these programs. Winners demonstrated exceptional commitment, creativity, leadership and success in achieving goals related to the conference theme.” Awards were given in the following categories:

•Changing Systems Award
•Changing Lives Award
•Exemplary Partnership Award

The 2010 Excellence in Action awardees:
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Virginia attorney general wants more outpatient treatment for mentally ill - washingtonpost.com

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By Tom Jackman

One of the best ways to treat severely mentally ill people, experts say, is with mandatory outpatient treatment rather than forcing them into hospitals or institutions. After the shootings at Virginia Tech by a mentally ill student in 2007, the Virginia General Assembly changed the law the next year to allow more outpatient treatment.

But even fewer people were ordered into outpatient treatment in the law's first year.

So on Thursday, new Attorney General Ken Cuccinelli II (R) will push for a new law that would allow doctors to order patients into outpatient treatment after they are stabilized in a hospital or institution.

The law could save Virginia considerable money and open up more bed space by getting stable patients out of hospitals, Cuccinelli said. The attorney general also is seeking an increase in the time allowed for mental-health professionals to examine and evaluate people once they are taken into custody. That also would give patients more time to stabilize.

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Medical News: Surgical Mistakes Continue Despite VA Initiative - in Surgery, General Surgery from MedPage Today

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By Nancy Walsh, Contributing Writer, MedPage Today

Despite a concerted effort to reduce them, surgical mistakes, particularly errors in communication, continue to occur in the operating room and elsewhere in hospitals, a Veterans Health Administration study found.

A total of 342 events were reported to a national database between January 2001 and June 2006, 212 of which were actual adverse events and 130 of which were close calls, according to Julia Neily, RN, of the Department of Veterans Affairs in White River Junction, Vt.

A total of 108 (50.9%) of the adverse events occurred in the operating room and 104 (49.1%) occurred in other locations such as procedure rooms and radiology suites, the researchers reported in the November Archives of Surgery.
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Long Term Care for Senior Veterans - Senior Counsel

By Lisa M. Powers
Since its establishment in 1930, the Department of Veterans Affairs has evolved to supporting and aiding the nation’s veterans in numerous ways. One of these services for example, the Veterans Health Administration, is the largest single provider of medical care in the United States. Its 22 regions with 154 hospitals and their associated 875 outpatient clinics offer the following services.

• Hospital, outpatient medical, dental, pharmacy and prosthetic services 

• Domiciliary, nursing home, and community-based residential care,

• Sexual trauma counseling,

• Specialized health care for women veterans

• Health and rehabilitation programs for homeless veterans

• Readjustment counseling,

• Alcohol and drug dependency treatment,

• Medical evaluation for disorders associated with military service in the Gulf War, or

• Treatment for exposure to Agent Orange, radiation, and other environmental hazards,

• HISA grants, Other special benefits

The Department of Veterans Affairs provides three types of long term care services for veterans:

• The first is health care benefits provided to veterans who have service-connected disabilities, who are receiving VA Pension or who are considered low income.
• The second benefit is state veterans homes.
• The third benefit for veterans is disability income programs.

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