OVERVIEW Kenneth Shay Director of Geriatric Programs Geriatrics and Extended Care Services Department of Veterans Affairs Kenneth.Shay@va.gov

Veterans Community VA Over 21 millions Veterans are alive in the US, but the VA has a relationship with only about 9 million of them. These Veterans live in our communities—the same communities that contain VA facilities. And the communities, generally, feel a debt of gratitude to Veterans and are motivated to identify ways for demonstrating their thanks.

VA Veterans Community VA care provided to Veterans Community care provided to Veterans A range of health-related program programs exist to assist everyone in the community—including Veterans. The VA has a broad array of such programs, but they can offer this service only to the Veterans they know about. And often the community agencies providing such services, are uncertain how they should deal with Veteran clients: should they refer them to VA? What if they cover services that VA doesn’t? How would they coordinate care? Ensure services are not redundant or conflicting?

VA Veterans Veteran-Community Partnership (VCP) Community Community care provided to Veterans VA care provided to Veterans VA A Veteran community partnership (VCP) brings together the VA groups who extend their services into the community, and the community agencies whose clientele includes Veterans, and gets them to interact and learn from one another. In this way more consistent and appropriate blends of care—blends that better suit each Veteran—can be achieved, even as the VA groups get to know more about their VA colleagues’ programs and learn a broader range of community sources.

VCP VA Veterans Community Groups or agencies concerned with homelessness, mental health, caregivers, …. Veterans Community corresponding VA offices VCP VA But the shared goals of health services are also shared with non-health-related community supports. Both VA and the community have programs that address transportation, homelessness, mental health, elder care, and caregiver issues. corresponding VA offices ….transportation, post-deployment, elder care, rural health…

VCP VA Veterans Community Groups or agencies concerned with homelessness, mental health, caregivers, …. Veterans Community corresponding VA offices VCP VA VCP-like partnerships could be developed to foster seamless service provision and improved care of Veterans. ….transportation, post-deployment, elder care, rural health… corresponding VA offices

VCP VA Veterans Community But, in the spirit of making the most of scarce resources, it makes better sense if the original “health-services-based VCP” serves as the foundation for the evolution of broader set of interrelated partnerships—rather than independent silos, each of which likely contains some elements of the each of the others.

V C P VA Veterans Community Veteran-Community Partnership = VCP We call that larger set of health-related partnerships a “Veteran-Community Partnership” (VCP). Different VCPs have different or expanded foci for Veterans—that may or may not include end of life challenges for Veterans - such as Caregiver issues, Alzheimer’s Disease, Homelessness, mental health, Veterans returning home from war and their families---and that may address several or all of these. Each one works by breaking down communication barriers between VA personnel and their community counterparts through the development and maintenance of interpersonal ties. This reduces the “mystery” and “faceless bureaucratic anonymity” of the VA, in the view of community providers and agencies. It also bolsters VA personnel’s ability to identify and access expanded sets of resources within the community on behalf of Veterans. Veteran-Community Partnership = VCP

Background There are over 22 million Veterans in the U.S. ~9 million Vets enrolled; 47% over age 65 Elderly Veterans are “10 years older” than age-matched non-Veteran counterparts More interacting diagnoses, drugs More functional dependence More caregiver needs and challenges 70% of VA patients over age 65 use one or more other healthcare services—yet there is no systematic linkage among providers/services Discontinuities in care and documentation Redundant and missed services

Veteran-Community Partnerships Vision All Veterans and their caregivers will have access to, and choices among, the services that allow our Veterans to stay in the place they call home. Mission To foster Veterans seamless access to, and transitions among, the full continuum of non-institutional extended care and support services in VA and the community. “Serving those who served for us”   The focus of the Veteran and Community Partnership (VCP) initiative is to foster seamless access to, and transitions among, the full continuum of non-institutional extended care and support services in VA and the community. Veterans deserve ready access and choice of the widest range of services available. Most Veterans are not enrolled in VA, and exclusively access community resources for their health and support care needs. Additionally, Veterans who do receive VA health services also access non-VA services. Therefore, it is imperative that VA and community agencies establish and nurture these partnerships. The need for VCP, which is an expansion on the concept of the Hospice-Veteran Partnership to a broader scope of service types and providers, reflects that community partnership and participation with VA providers is an invaluable asset to all stakeholders and veterans. The VCP also acknowledges and aims to support caregivers of our Veterans, as they play an indispensible role in the care and lives of our Veterans. Each local VCP will be unique according to the diversity of resources within its community, will build on its local resources and strengths, and thereby will facilitate collaboration and involvement of all partners. VCP will provide a mechanism to integrate knowledge and action for the combined mutual benefit of all those involved, and for those for whom they care.

What is a VCP? Veteran Community Partnerships (VCP) are formalized partnerships through which local VA facilities connect with state and local community service agencies in an effort to: Enhance and improve access to and quality of care Promote seamless transitions Educate community agencies & VA providers Support caregivers Develop and foster strong relationships between VA and community agencies and providers Formalized Partnership Definition: An alliance among individuals, agencies, or groups, that cooperates in joint action, each in its own self-interest, joining forces together for a common cause and mutual benefit of all those involved.

VCP Principles Person Centered Increase Access Create Choice Provide best care Mutual support

VCP Origins and Status Hospice-Veteran Partnerships (HVP) (2002) Geriatrics & Extended Care strategic plan (2008) VCP Pilot Sites (2010 - 2011) Albany, NY Manchester, NH Battle Creek, MI Contract with NHPCO (2011) VCP Trainings (2012 - current) VISN 8 – January 2012 VISN 11 – May 2012 VISN 6 – June 2013 VISN 4 – March 2014 VISNs 18, 20, 21 (VA Rural Health) – January 2014, follow up May 2014 VCP-HVP – November 2015 VISN 20 – (combined with COVER-to-COVER) – October 2016 VISN 9 – (combined with COVER-to-COVER) – December 2016 Total VCPs – 56 VA sites trained, in 24 states and 17 VISNs* * Note: VISNs are the Veterans Health Administration’s Veterans Integrated Service Networks; see https://www.va.gov/directory/guide/division.asp?dnum=1. At the State of the Art Conference i(SOTA)n 2008 caregiving issues was the number one identified concern and need from participants. New Geriatrics and Extended Care (GEC) strategic plan specifically identifies and requires attention to caregiver issues, and charges VA to create VCPs HVP- came out from the Palliatiave care initiative about 10 years ago. The HVP have been largely successful. Many of you VA employees here probably are familiar, or are part of your facilities VCP They have had many success stories, many VISNs have conferences, have broke down and dismantled some frustration with hospice and palliative care agencies. Have smoothed out many issues with contracting, and have worked tirelessly to ensure that our Veterans are able to access their benefit. Silos- Well the reason it was part of the intial concept of a VCP is that they do exist. I was a private sector social worker, an VA was a large monstor that I had no real idea how to get near. Sharing information was/is difficult with private sector and VA. HIPPA, patient confidentiality, applying for benefits, etc. But also within VA. Not knowing what the other hand is doing. We need to work together to MAXIMIZE our own internal resources as well. Many offices are working and aiming to develop greater community relationships. I hope that the Veteran-Communitiy Partnership will actually facilitate this for all VA, to inform and be value added to everyone’s efforts.

VCP Locations (Sites Trained) Rural Health Sites – VISNs 18, 20, 21 – AK, WA, CA, AZ, TX (6) VISN 10 & 12 Facilities - IL, IN, MI (7) VISN 2 – Albany, NY (1) VISN 1 – Manchester, NH (1) VISN 20 Facilities - WA (2) w/ C2C VISN 4 - PA and DE (9) VISN 9 Facilities – KY, TN (5) w/ C2C VISN 5 & 6 Facilities – WV, VA, NC (8) HVP to VCP Sites – AR, So. CA, No. CA, MT, NE, NJ, FL, OH, PA, NC, GA (11) VISN 8 Facilities (7)

Who is Involved? Community Partners: VA Medical Center Partners: Veterans Veterans Services Organizations Hospice-Veteran Partnerships Community, county, and state human services agencies Aging network Caregivers Caregiver coalitions Academic institutions Service Organizations Faith-based organizations Non-profits Charitable organizations Philanthropic organizations Hospice organizations Home care agencies Respite organizations Disability groups VA Medical Center Partners: Hospice and Palliative Care VA Voluntary Service OIF/OEF program Social Work Service Nursing Service/Community Health Mental Health Service Geriatrics and Extended Care Office of Public Affairs Homelessness Each local VCP will be unique according to the diversity of resources within its community, will build on its local resources and strengths, and thereby will facilitate collaboration and involvement of all partners. VCP will provide a mechanism to integrate knowledge and action for the combined mutual benefit of all those involved, and for those for whom they care.

VCP National Advisory Council Administration for Community Living* Disabled American Veterans* LeadingAge (formerly American Association of Homes and Services for the Aging) * National Alliance for Caregiving* National Association of Area Agencies on Aging* National Hospice and Palliative Care Organization* VHA Hospice-Veteran Partnership Workgroup VHA Office of Care Management and Social Work VHA Office of Community Engagement VHA Offices Geriatrics and Extended Care and Operations VHA Office of Nursing Service VHA Office of Primary Care Services and Operations VHA Office of Rural Health * ex officio members

Activities of VCPs Conduct assessments to determine the unique needs of Veterans within communities Exchange information between VA and community agencies in an effort to keep both informed of local and VA resources, strengths, and potential growth areas Educate community agencies about specific veteran-related issues and benefits Conduct community outreach educational programs for veterans groups/community agencies to provide information on the VA continuum of care, available resources, and options Hold local/regional/statewide educational events for both community and VA stakeholders to provide information on the continuum of care options and VA healthcare system Create/disseminate educational tools that partners can access for the most current and complete information on resources for veterans, in VA and in the community…And more! Conduct assessments: work with partners. Identify the needs of the local community. Is it ADHC? Transportation? Bring that back to VA leadership as well as your partnerorg. National leadership. Identify a project that the group wants to work on collaboratively. This is so important. Exchange information- What is going on in your VA? What are the services available? How do you get benefit information? What is your state or community working on? Educate- Share information have a dialogue or present at local/state conferences. Inform partners of the unique needs our Veterans may have and how they may be affected. Offer partners the same opportunites Hold events and outreach activities- could be a health fair at a local ADCH or senior center. Get involved in university outreach Create educational tools to share. Websites, Wiki-sites, social networking sites. Find out if any of your potential partners have the infrastructure to help manage a working website where all parties can post information.

Feedback about VCP “VCP activities have opened doors to building stronger relationships with community agencies.” “I thought VCP was going to be another responsibility to add to my already overflowing plate—but it has really provided me the very tools I was looking for to help me do my job more effectively.” “VCP has provided opportunities to represent the VA in a positive light.” “VCP has provided education to community agencies that was unknown prior – including myths re: enrollment & eligibility.” “VCP is key to a strong foundation for ongoing collaboration, trust and mutual respect.”

VCP Resources – Toolkit, Reports, Etc.