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VA treats over 6 million veterans yearly.
Did you know
more than half of VA outpatients
are over age 65,
or that nearly a third are over 75?
I'm Ken Shay,
Director of Geriatric Programs
at the Veterans Health Administration.
As people age, chronic diseases
make many of them dependent on someone else
just to get through the day,
get out of bed, get dressed, or take medications.
When these needs are more than family
or friends can handle,
professional help is needed.
Since the 1990's,
VA has been moving away
from addressing such needs in nursing homes
and instead has developed a variety of approaches
permitting dependent, aging veterans
to choose to remain at home, in the community,
among friends and family.
VA's Geriatrics and Extended Care Strategic Plan
directed us to adopt new, but proven services
to expand veteran's choices for care.
Our Undersecretary for Health committed VA
to provide care that is above all patient-centric,
configured around the needs of each patient
rather than around existing facilities and processes.
He has pledged
we will deliver care to America's veterans
that is accessible,
evidence-based, and continuously improving.
I'm really excited to share with you
our stakeholders and customers,
some examples of VA's non-institutional alternatives
to long-term care.
A sample from nearly 80 programs
introduced since 2009,
in sites from Vermont to Virginia,
San Francisco to Florida
that provide dependent, elderly veterans
and those who care for them
a range of proven new choices
for staying connected
with their families, their communities,
and with the country they fought to protect.
Hi! I'm just going to take your blood pressure, okay?
In September my husband became very, very ill.
We were spending more and more time in the hospital,
in the ER.
He dealt with depression sometimes,
because he would much rather be home.
Program at Home is a research-based
home hospital program
that is run by physicians and nurses
with the goal of either preventing hospitalization
or getting patients out of the hospital earlier.
Program at Home started ten years ago
by delivering care through house calls.
We were making house calls again and delivering care
just like in the hospital,
but in the comfort of someone's home.
So I'm going to draw your blood today and then...
We're able to provide EKG's.
We have point-of-care lab testing.
We can give them IV antibiotics or diuretics,
whatever they need.
We can make sure
that they're taking their medications correctly,
because there is a lot of changes for medications
in the hospital.
Well, as a caregiver
you don't want to give the wrong medication.
Just to be able to pick a phone up
when you feel like you're in crisis and say,
you know, Dr. Acosta, this is going on,
and then he calls the nurse
and explains to the nurse what's going on,
you're not left alone.
When we can get patients out
to their homes from the hospital
in a safe and quality environment,
with the supports they need,
that opens up beds for
other patients to come in and utilize.
-Morning! -Well, good morning!
The patients recover just as quickly,
just as safely,
and the complication rate
for things like confusion and falls was lower
than if the patient had been in the hospital.
Beautiful!
Patients love it, families love it,
we feel honored to be able to deliver this service
to people who served our country.
With home health he's home and he's secure
and we have a lifeline.
My mother was feeling overwhelmed and depressed
taking care of my father who has dementia.
The Coatesville VA has a program in place
to help my parents and other veteran families.
The name of the program is
Dementia Competencies at Home
and the mission is
to maintain our veterans in their home
through dementia care education
and support to their caregivers.
First we assess veterans in the Golden Memory Clinic.
We examine them for their memory and functional status.
We also assess the caregiver's burden.
After the initial consultation,
I schedule a home visit with the caregiver.
One of my greatest concerns
is to create a safe environment for our veterans.
I go over things like fall prevention,
firearms in the home,
and wandering caused by dementia.
I help caregivers get the tools they need
to keep their home safe.
We can also keep in touch with caregivers
through regularly scheduled video visits.
This way they can have face to face time
and we can see if the caregiver seems stressed or rundown.
There's also a touch screen device on the video unit
with a series of questions
that the veteran can reply to on a daily basis.
Their answers help us assess
their functional status and mood.
The program has been a real benefit to my family.
I don't worry as much about my mom and dad.
It's been a blessing.
We always tell our veterans and caregivers,
we are here to serve you
since you served our country.
The first facility that we put him in
wasn't able to handle him,
because he kept walking off
and would not stay in the facility.
It was very difficult.
He was becoming unmanageable
and I was just at the end of my rope.
I just didn't know what to do.
When the PACE program was offered to me,
it was like a godsend.
It was a burden lifted off my shoulders.
The role of PACE is to provide
all inclusive care for the veterans,
just about any service that they might need
is provided here in one location.
They have doctors, nurses,
occupational therapists, recreational therapists...
We're going to sway from left to right...
...Physical therapists...
We're going to do the bicycle okay?
...Pretty much comprehensive care for the patient
on a day-to-day basis.
They play music.
He likes to play the guitar.
They dance. He loves to dance.
What is different about PACE
is it flips the traditional
acute care model on its head.
It enables us to really focus on preventative medicine
and allows us to really take care of the patients
wherever they are.
They took care of his personal needs
as well as his physical needs.
I was able to go to work
and know that he was really being taken care of.
We are here to provide
the best care possible for veterans
and PACE has become an integral part of that.
You see the smiles, you see the interaction
they're having with the staff,
it's a great program.
Without the PACE Program
I would be totally exhausted all the time
and probably in a depressed state.
So this has really, really helped me,
like I said, it's just a godsend.
With the aging of the veteran population,
there's a growing demand
to address multiple medical
and mental health problems in a timely way.
This model, integrating geriatrics and mental health,
embedded in primary care,
is uniquely suited
to better manage older veterans' medical
and psychosocial needs.
For example,
an elderly veteran presents
to primary mental health care
because of family concerns
of a change in mood or behavior.
During the psychiatric interview
the mental health provider determines
that a geriatric assessment
to screen for dementia
or other geriatric syndromes is indicated.
A member of the geriatric team is contacted
and the veteran is seen,
usually the same day
instead of waiting up to 45 days.
Standard eye screening tools evaluate caregiver stress
and cognitive and functional capacity.
Social and psychiatric evaluations
give us a sense of the health risk,
social support, and physical limitations,
all within the primary care setting.
Typically in primary care,
social work services are reactive.
This program is much more proactive.
We're often able to do an evaluation
before a problem begins
and monitor the veteran's progress
closely over time.
That's better for the veteran,
the family, and the VA.
Our goal is to identify elder veterans at risk,
manage geriatric syndromes,
and promote independence.
Furthermore,
this pilot program functions as a Geri Pact,
dramatically improving access for our veterans
and reducing costs for the VA.
My dad was admitted into the hospital
and after they released him
he was enrolled in the GRACE Program.
...Go ahead and check your blood pressure now,
is that okay?
Our goal for GRACE is to serve as many veterans
and their caregivers as possible,
keeping them in their home
as healthfully and functionally and safely
as we possibly can.
I have been receiving wonderful, wonderful care.
I couldn't get along without the GRACE Program.
Whatever we need, they get it for us.
What makes GRACE so effective is that the GRACE team,
comprised of a nurse practitioner and social worker
act as a liaison with the VA primary care provider
and then we bring the home perspective
back to the team of geriatricians,
pharmacists, psychologists,
social workers, and nurse practitioner.
When they first came out, Ericka, the social worker,
she was telling us all about the program,
and Rebecca, the nurse practitioner,
she was here to meet his health need.
He doesn't have to go out a hospital.
She is here to, you know, check him out.
The VA is moving forward
to provide 21st Century care
that is patient-centered.
Being in the home is critical.
We're able to assess and evaluate
and meet the patient's needs better
with this perspective.
We have served over 260 veterans and their caregivers
so far in the last two years
and we are thrilled with the results we are seeing.
We have seen a decrease
in their 30-day hospital readmission rate
by almost half.
In the last year we have been able to save
over 60 hospital admissions for these veterans
and saved 400 bed days of care
for our VA Medical Center.
Looking really good!
-Keep up the good work! -Thank you!
They're caring people
and it really makes me feel good
to have them to come into the home
and care so much about my dad.
I've lived here almost 20 years
and the Tampa VA team
has helped me stay in my home
and out of the hospital.
I think that it is very clear
that frail elderly veterans
are at high risk for re-hospitalizations
due to medication confusion,
home safety issues,
and many other factors.
The Home Based Transitional Care Program
significantly reduces readmission rates,
especially within 14 days of a hospitalization.
Within four days of a hospital discharge,
a nurse and a therapist
will do an in-home evaluation and assessment.
The nurse specifically
will focus on the hospital discharge plan of care
with the patient and his caregiver.
I find that you see the true picture
when you go into the home.
I do follow up care for the veteran
for up to 28 days after discharge,
and one of the most important things that I do
is education about their medication management.
Often patients are confused about medication changes
and that can be a serious safety issue.
As a kinesiotherapist I complete a functional
and environmental assessment in the home
and order adaptive equipment
such as grab bars and wheelchair ramps,
anything to prevent falls,
which is a common cause of hospital readmissions.
Based on our satisfaction surveys,
95% of the veterans say
that Home Based Transitional Care Program
increased their overall satisfaction with the VA.
We are committed
to keeping our valued veterans safe and at home.
As you have seen,
these pilot programs are enhancing the choices
available for veterans,
by allowing them to stay at home
among family and friends.
What do you think?
Your VA stakeholders,
our leaders, our clinicians, and American taxpayers,
each of you is an important,
our most important judge
as to whether we are delivering accessible,
proven services for our aging veterans,
the men and women
who made sacrifices to serve and protect our nation.
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