VA Boston Healthcare System: Supportive Programs for Veterans and their Caregivers Olga Quinlan, LICSW Dementia Care Coordinator VA Boston Healthcare System February 4, 2014

VA Boston Healthcare System Jamaica Plain Division 150 S. Huntington Avenue Boston, MA | West Roxbury Division 1400 VFW Parkway West Roxbury, MA | Brockton Division 940 Belmont Street Brockton, MA |

Community Based Outpatient Clinics (CBOCs). Causeway Street (Boston) CBOC 251 Causeway St. Boston, MA Phone: Or Framingham CBOC 61 Lincoln Street, Suite 112 Framingham, MA Phone: Lowell CBOC 130 Marshall Road Lowell, MA Phone: Plymouth CBOC 116 Long Pond Road Plymouth, MA Phone: Quincy CBOC Quincy Medical Center, 2nd floor114 Whitwell St Quincy, MA Phone:

VA Health Benefits Veterans Health Benefits Guide and Health Care Benefits Overview The VA Boston Healthcare System Enrollment Office VHA Health Benefits Website MyHealtheVet VA toll-free VETS (8387) between 8:00 AM and 8:00 PM ET, Monday-Friday

VA Shared Care Policy VA believes best care is coordinated by a single primary care provider, as this provides the highest degree of coordination and safety to patients, which is why VA requests that patients get all primary care from a VA primary care provider. However, some patients choose to be followed by a non-VA primary care provider and “share” their care (or out of geographic need). If you choose to be followed by a non-VA primary care provider, your VA primary care provider is under NO obligation to re-write medication prescriptions or to follow instructions given by that provider. Veterans seeking care, medications or supplies from the VA MUST be enrolled in AND have a minimum of one visit ANNUALLY, that may include lab and other testing, with a VA Provider (VHA Directive ). The Veteran is responsible for informing non-VA provider(s) that they are being cared for in the VA and for giving their VA primary care provider the name and address of all other provider(s) the Veteran is seeing.

VA Primary Care Patient Aligned Care Team (PACT) Primary Care Teams consist of:  Primary Care Provider - MD, Nurse Practitioner (NP)  RN – Nurse Case Manager  MSW- Social Worker

Process/ Access to Care- Primary Care Provider Referrals/Consults Medical and Supportive Services Inpatient and Outpatient referrals Specialty care (Oncology, Dermatology, Cardiology, Neurology, Psychology/Psychiatry, Podiatry, Urology, Radiology) Social Work and Mental Health Programs

VA Programs with Social Work Involvement (A-G) Adult Day Health Care – VHA and Contract (ADHC and CADHC) Blind Rehabilitation/Low Vision (VIST- Visually Impaired Systems Teams) Care Coordination – Home Telehealth (CCHT) Caregiver Support (Various Programs) Caregiver Support Coordination (CSC) Community Based Outpatient Clinics (CBOCs) Community Living Center (CLC) Contract Nursing Home – Contract (CNH) Community Residential Care (CRC) Dialysis (at Jamaica Plain) Domiciliary (DOM) Fisher House (West Roxbury) Geriatric, Research, Education, Clinical Center (GRECC)

VA Programs with Social Work Involvement (H-M) Health Care for Homeless Veterans (HCHV) Home Based Primary Care (HBPC) Hoptel (Huntington House at Jamaica Plain) Housing and Urban Development- Veterans Administration Supportive Housing Program (HUD-VASH) Infection Control (HIV Program) Intern Program- Social Work (various locations) Medical- Inpatient (West Roxbury and Transitional Care Unit Brockton) Mental Health- Inpatient (Brockton) Mental Health- Outpatient (General and Geriatric MH – GMH/Gero MH) Mental Health Intensive Case Management (MHICM) Military Sexual Trauma (MST) MOVE Program

VA Programs with Social Work Involvement (N-R) Neurology/Neuro Memory Disorders Clinic Oncology Operation Enduring Freedom/Operation Iraqi Freedom Care Management (OEF/OIF/OND) Organ Donation (Primary Care screenings/Renal clinic JP) Palliative Care/Hospice Program (Inpatient and Outpatient) Polytrauma (TBI Program) Post Traumatic Stress Disorder (PTSD) POW Program Primary Care Clinic Psychosocial Recovery and Rehabilitation Center (PRRC) Rehabilitation – Medical Respite Care Program

VA Programs with Social Work Involvement (S-W) Serious Mental Illness section (SMI). Smoking Cessation Social Work Administration Social Work Veterans Integrated Service Network (VISN) Lead Spinal Cord Injury (SCI)- Inpatient/Outpatient Substance Abuse/Addictions Treatment Program (ADTP) Suicide Prevention Coordination Program (SPC) Surgery (Surgical units West Roxbury) Transplant Traumatic Brain Injury (TBI) Veterans Justice Outreach (VJO) VIST Coordinator (see Blind Rehab) Vocational Rehab Women’s Veteran’s Program

VA Caregiver Support Program Public Law : Caregivers and Veterans Health Service Act of 2010 Mandatory Caregiver Support Signed into Law May 5, 2010 National roll-out of Caregiver benefit on May 9, 2011

VA Caregiver Support Program Components Family Caregiver Program General Caregiver Program Caregiver Support Line

1- Family Caregiver Support Program Eligibility Criteria Administrative: ▫ Post September 11, 2001/Line of Duty Injury- enrolled in VA care or member of Armed Services (DoD process) ▫ Injury was in fact incurred or aggravated in the line of duty Clinical: ▫ Based on functional limitations - need for assistance- Inability to perform one or more activities of daily living ▫ Need for supervision or protection - Focus on safety and need for supervision as well as assistance with personal care services.

Family Caregiver Support Program: Application and Assessment Joint application for Veteran & Family caregiver  VA Form10-10CG (Caregiver)  Unrelated caregiver must live with the veteran  Assessment of veteran by Primary Treatment Team  Assessment of proposed caregiver by CSC  Caregiver training by Easter Seals  On-line  Workbook  Initial Home Visit- Subsequent visits

Family Caregiver Support Program: Benefits Stipend ▫ Direct payment to family caregiver ▫ Centrally funded and managed ▫ Based on wages of a home health aide ▫ Tier based on Veteran’s specific needs for care Health Insurance Expanded Respite Care Travel and Lodging Mental Health Services

2- General Caregiver Support Program Eligibility Criteria Any era Veteran/Caregiver In need of Personal Care Services because of: ▫ an inability to perform one or more ADLs - OR - ▫ a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury

3- Caregiver Support Line

VA Caregiver Support Coordination Program VA Boston CSC Coordinators:  Renee Gallagher, MSW, LICSW:  Julia Lehmann, MSW, LICSW:

Dementia Care Coordination (DCC) Program DCC is relatively new program (implemented January 2010)- designed to provide proactive and supportive interventions to veterans diagnosed with Alzheimer's disease, and/or other Dementia diagnoses AND their informal/family caregivers. Interventions range depending on severity of condition and disease process from "early stages" throughout "later stages" of dementia in the following domains:

DCC Program Scope of Services Dementia Clinical Case Management o Clinical Assessment of veteran’s needs o Clinical Assessment of caregiver(s) needs Caregiver Support/Education -Individual (face to face), telephone outreach, caregiver support group (BR). Coordination of care – VA and assistance with Non-VA transitions of care, partnerships with Elder Services and Alzheimer’s Association. Caregiver support and education- Ongoing assessment/monitoring- Collaboration with VA treatment teams. Staff education/consultations Administrative oversight

Dementia Care Coordinators Olga Quinlan, MSW, LICSW- Brockton Division 940 Belmont Street Brockton, MA Tel: Gayle Clark, MSW, LCSW- Jamaica Plain Division 150 S. Huntington Avenue Boston, MA Tel: Mondays 8:00AM- 12:00PM

VA Supportive Programs In-Home Care ▫ Homemaker Home Health Services (H/HHA) ▫ Skilled Home Care (VNA) ▫ Home Based Primary Care (HBPC) ▫ Telehealth (Care Coordination/ Tele-health) Respite Care ▫ In-Home ▫ Adult Day Health Care ▫ In-Patient Additional Benefits ▫ Financial Benefits – (i.e. Aid & Attendance, Vet Directed Program) ▫ Support Groups ▫ Prosthetics

Veteran’s National Crisis Line TALK (8255) ** Press 1 for Veterans

References - VA Websites MyHealtheVet Prosthetics and Sensory Aids VA Social Work Programs VA Boston Healthcare System VA Shared Care Policy VHA Social Work Program Guide

Thank you!! Questions?