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In July of 2011 Dr Thomas Edes Director of the Geriatrics and Extended Care Office of Clinical Operations of the U.S. Department of Veterans Affairs presented on the “Impact of VA Home Based Primary Care” at a National Health Policy Forum. Dr Edes reported on the positive outcomes for new programs that deal with treatment of veterans at their homes as opposed to in outside traditional healthcare settings. Home Based Primary Care (HBPC), treatment includes in home support from a treatment team consisting of nurses, medical doctors and social workers/therapists. Dr Edes report indicated that the HBPC allowed for “greater access, better care, at a lower cost” to veterans who qualify for in home care. In addition, Dr Edes reported about a program called the VA Medical Foster Home program, which is at its core an adult foster home system especially for veterans and includes in home care. With actual testimonials and examples, Dr. Edes presented realistic and impactful statistics that credited reports that HBPC and VA foster homes were more efficient, effective and better prepared to give veterans the services they need.
Unfortunately there are many obstacles in the way to providing this type of care including financial, bureaucratic and political issues. Financially, although less expensive than traditional nursing or skilled facilities, HBPC is still pretty expensive from the perspective of the service provider especially in such a down economy. The continued practice of shuffling veterans into the VA or their affiliates is still far from being a thing of the past. Wait lists continue to be extensive and many facilities are understaffed to provide the intensive and sometimes demanding services associated with such a high level of care. Some estimates include an average total cost for services (within the last decade) at roughly $50K per client served for traditional facility stays. HBPC is associated with overall lower cost percentage per client per year (in some instances as much as a 25% annual cost reduction), yet it is still considered an expensive proposition for many service providers who are new to contracting with the VA or are used to the stability of prior contractual interactions with a steady flow of veteran populations referred from the VA. In addition, there are political issues associated with high level government funding for VA benefits, especially with newer and less traditional ways of caring for veterans. There are some who continue to believe in the traditional medical model way of treating clients in a very structured care environment as opposed to a more Recovery oriented way of treating clients. This political and philosophical debate continues today and often stands in the way of change.
Lastly, the bureaucracy involved with attempting to obtain HBPC can sometimes be overwhelming and a daunting task. It is true that the VA has been successful with electronic health charting, but there is still wait times, lengthy reviews of information and all the things associated with such a massive bureaucratic system that services hundreds of thousands of clients each year. In addition it all starts with the veteran’s willingness to want the services, his or her ability to get the services and basically knowing where to begin.
In order to qualify for services a veteran must either go to a VA facility, or contact the VA by telephone or through the internet. This can be an overwhelming task for a veteran suffering from medical or mental health issues or both. Often time’s veterans have no one to assist them with this process such as relatives or social service workers. If the veteran does have someone to assist them, this can also be a confusing and overwhelming process. There are agencies that assist with this such as:
These agencies assist veterans or their spouses with obtaining VA benefits and potential services in home and have field offices throughout the United Sates. In addition, the VA website lists a lot of the necessary information needed to obtain VA benefits including electronic forms and resources for those who need them. There is also a very well written and informative article in this journal from 2008 that reviews basic information.
For more information, try the links below: