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

2. VA Boston Healthcare System Jamaica Plain Division 150 S. Huntington Avenue Boston, MA 02130 617-232-9500 | 800-865-3384 West Roxbury Division 1400 VFW Parkway West Roxbury, MA 02132 617-323-7700 | 800-865-3384 Brockton Division 940 Belmont Street Brockton, MA 02301 508-583-4500 | 800-865-3384

3. Community Based Outpatient Clinics (CBOCs). Causeway Street (Boston) CBOC 251 Causeway St. Boston, MA 02114 Phone: 617-248-1000 Or 617-248- 1000 Framingham CBOC 61 Lincoln Street, Suite 112 Framingham, MA 01702 Phone: 508-628-0205 Lowell CBOC 130 Marshall Road Lowell, MA 01852 Phone: 978-671-9000 Plymouth CBOC 116 Long Pond Road Plymouth, MA 02360 Phone: 774-826-3733 Quincy CBOC Quincy Medical Center, 2nd floor114 Whitwell St Quincy, MA 02169 Phone: 617-376-2010 http://www.boston.va.gov/

4. VA Health Benefits Veterans Health Benefits Guide and Health Care Benefits Overview http://www.va.gov/healthbenefits/resources/epublications.asp http://www.va.gov/healthbenefits/resources/epublications.asp The VA Boston Healthcare System Enrollment Office VHA Health Benefits Website http://www.va.gov/healthbenefits/http://www.va.gov/healthbenefits/ MyHealtheVet https://www.myhealth.va.gov/index.htmlhttps://www.myhealth.va.gov/index.html VA toll-free 1-877-222-VETS (8387) between 8:00 AM and 8:00 PM ET, Monday-Friday

5. 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 2002-074). 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. http://www.boston.va.gov/questions.asp http://www.boston.va.gov/questions.asp

6. 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

7. 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

8. 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)

9. 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

10. 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

11. 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 http://vaww1.va.gov/vhapublications/

12. VA Caregiver Support Program Public Law 111-163: 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

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

14. 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.

15. 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

16. 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

17. 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

18. 3- Caregiver Support Line www.caregiver.va.gov

19. VA Caregiver Support Coordination Program VA Boston CSC Coordinators:  Renee Gallagher, MSW, LICSW: 617-248-1159  Julia Lehmann, MSW, LICSW: 857-364-3722

20. 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:

21. 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

22. Dementia Care Coordinators Olga Quinlan, MSW, LICSW- Brockton Division 940 Belmont Street Brockton, MA 02301 Tel: 774-826-2096 Gayle Clark, MSW, LCSW- Jamaica Plain Division 150 S. Huntington Avenue Boston, MA 02130 Tel: 774-826-2834 Mondays 8:00AM- 12:00PM

23. 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

24. Veteran’s National Crisis Line 1-800-273-TALK (8255) ** Press 1 for Veterans

25. References - VA Websites MyHealtheVet https://www.myhealth.va.gov/index.htmlhttps://www.myhealth.va.gov/index.html Prosthetics and Sensory Aids http://www.prosthetics.va.gov/HISA2.asphttp://www.prosthetics.va.gov/HISA2.asp VA Social Work Programs http://vaww1.va.gov/vhapublications/http://vaww1.va.gov/vhapublications/ VA Boston Healthcare System http://www.boston.va.gov/http://www.boston.va.gov/ VA Shared Care Policy http://www.boston.va.gov/questions.asphttp://www.boston.va.gov/questions.asp VHA Social Work Program Guide http://vaww1.va.gov/vhapublications/http://vaww1.va.gov/vhapublications/

26. Thank you!! Questions?