1. Chronic Illness, Participant Direction and Well-Being Nancy L. Wilson, MA, LCSW

2. Why I toast this union…and its future Aging Network and Veterans Health Administration

3. Chronic Care Challenges of Veterans and Families Medical management of a condition: diet, meds, monitoring, physical routines Creating and maintaining meaningful life roles regarding jobs, family and friends (Corbin and Strauss, 1988) Coping with the anger, fear, sadness of having one or more chronic conditions-many “suddenly life altering.” (Corbin and Strauss, 1988)

4. Common Medical Illnesses and Depression Major Depression Stroke Multi- condition Seniors Diabetes 23% 11-15 % 30-50% Heart Disease 15-20%

5. What we are learning.. Patients, clients are experts in their lives-so we need to “build better versions”: work collaboratively Active engagement in identifying goals and learning how to solve problems builds “self-efficacy” or confidence to address today’s and tomorrow’s problems

6. Feeling Better by Doing Better..with support Mr. Wilson- 58 year old veteran of Vietnam War with diabetes, vision loss, amputation—lifelong health issues Chronic, recurring depression Lives alone in subsidized housing-strong ties to friends, other former vets Struggles with trusting “strangers” from home care.

7. How could participant directed approaches to care help?

8. “Out of town-Out of luck” Mr. Bell-42 and married with 2 children (9,13) Returns from Iraqi service with significant hearing damage, spinal cord injury (paraplegia), post-traumatic stress disorder Wife’s work requires shifts-unpredictable Reside in mobile home community approximately 125 miles from nearest VAMC SPI Center After rehab, family and friends wants to offer him “care that he deserves” yet barriers abound

9. Self-Direction Aligned with Recovery and Rehabilitation VA Health and Mental Health Services can offer treatment, teach skills, etc. Veteran needs support to apply skills Involves work outside of “8-4:30” Involves “home based” follow-up in daily routines of veteran: meds, relationships, self- identity Invaluable role of peer support Environmental adaptation

10. “Who knows best?”