1. HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING - WITH REAL-WORLD PERSPECTIVE. Administration for Community Living (ACL) and Veterans Health Administration (VHA) March 13, 2013 VD-HCBS Quarterly Educational Webinar

2. www.lewin.com 1 Administration for Community Living (ACL) & Veterans Health Administration (VHA) Quarterly VD- HCBS Webinar Today’s Featured Speakers: ► Jill Snider-Meyer, Community Based Programs Manager, Milwaukee VAMC ► Lisa Drouin, Wisconsin VDHCBS Project Manager, Greater Wisconsin Agency on Aging Resources (GWAAR) ► Dan Schoeps, Director of Geriatrics and LTC Purchasing, Veterans Health Administration ► Patrick O’Keefe, Program Analyst, Geriatrics and Extended Care, Veterans Health Administration ► Lori Gerhard, Director of Office of Integrated Programs, Administration for Community Living ► Kevin Foley, Administrator of VA & HCBS Programs, Administration for Community Living

3. www.lewin.com VD-HCBS NATIONAL STATUS 2

4. www.lewin.com VD-HCBS: Status and Future Direction 42 Operational Programs nationwide Continued Expansion ► 6-10 new sites over next 6 months Funding Sources ► Reviewing the Executive Decision Memo ► Rural health options ► Other VHA sources 3

5. www.lewin.com Veteran-Directed Respite New respite option for Veterans enrolled in the Program of Comprehensive Assistance for Family Caregivers (Stipend Program). Creative alternative to traditional respite care to meet the needs of the unique population being served. Quick Start to Occur at Central Texas VAMC. VD-HCBS expansion possibilities through VDR. 4

6. www.lewin.com 5 VDHCBS Collaborative Partnership Zablocki VAMC State of Wisconsin, Department of Health Services, Bureau of Aging and Disability Resources Greater Wisconsin Agency on Aging Resources, Inc. (GWAAR - AAA)

7. www.lewin.com A comparison of Veteran-Directed Home Care Program vs. Community Nursing Home Placement Jill Snider-Meyer, LCSW Community Based Programs Manager, Milwaukee VAMC March 13, 2013

8. www.lewin.com Study Contributors Jill M. Snider-Meyer, LCSW Alison J. Byrne, PhD Debra A. Levine, MSN, MHA, CPHQ Susan K. Gresser, MS, GCNS-BC, APNP Heather M. Smith, PhD Frederick J. Kier, PhD, MSHCA 7

9. www.lewin.com Study Overview The study compared the cost effectiveness of a Veteran-Directed Home and Community Based Services Program (VD-HCBS) with traditional Community Nursing Home (CNH) care. The study retrospectively compared the costs of care and patient satisfaction ratings of 23 patients in the VD-HCBS program with a sample of 31 controls in the VA CNH Program. 8

10. www.lewin.com Purpose / Method The purpose of this study is to compare the cost of effectiveness and patient satisfaction of a VD-HCBS Program compared with traditional NH care. Retrospectively compared the costs of care and patient satisfaction ratings of 23 VD-HCBS Veterans with a sample of 31 controls in the CNH program as well as demographic and diagnostic data. Five Diagnoses were recorded: dementia, hypertension, diabetes, congestive heart failure (CHF), and major mental illness. An “other” category was created for other major diagnoses that would necessitate CNH or VD-HCBS level of care, such as cardiovascular accidents (CVAs), multiple sclerosis (MS) and head trauma (TBI, anoxic brain injury, etc.). 9

11. www.lewin.com Results The average cost of care for a Veteran in the VD-HCBS program is less than half of that of CNH placement. Cost savings for 25 Veterans would amount to almost one million dollars per year. Note that the data do not include any medical or specialist care costs that might be incurred. The VD-HCBS group had more female and minority Veterans and was, an average, 9 years younger. Both groups had roughly the same number of Veterans with significant mental illness although the VD-HCBS group had fewer individuals with dementia than the CNH group. Both groups showed a high level of co-morbidity between physical and mental illness. 10

12. www.lewin.com Results Continued Both groups of Veterans were service connected anywhere from 70% to 100% service connected which is considered fully disabled, indicating that both groups consisted of Veterans with severely disabling conditions. Veterans participating in the VD-HCBS program generally reported satisfaction with the services being offered. 11

13. www.lewin.com Discussion The results support the VD-HCBS is less expensive than CNH care. This cost difference makes sense when one considers all of the additional expenses inherent in NH care, such as food, 24/7 nursing home level of care, maintenance of the NH environment, medications etc. On the other hand, the Veterans in the VD-HCBS obviously can function without these additional aspects and services that a NH provides. In a sense, the costs saved by the VD-HCBS program consist of money from CNH services that are not really needed or necessary, since the Veteran in VD-HCBS is able to live at home without them. 12

14. www.lewin.com Additional Discussion The VD-HCBS group is, on average, younger by almost a decade. In addition, the VD-HCBS group has fewer Veterans with dementia than the CNH group. This makes sense, in that older adults with dementia tend to not only need a dedicated caregiver, but also environmental interventions and restrictions, such as those found on a CNH dementia unit, to ensure adequate safety. 13

15. www.lewin.com Medical Center Response Data from the study was presented to VAMC leadership. VAMC leadership moved to support the program with local funding including expansion. 14

16. www.lewin.com Initial Focus/Goal Attempt to relocate veteran from a CNH level of care to home using Self Direction Initially were able to identify some veterans who might be appropriate, however they did not have the supports available to return home Currently have veteran identified who will enroll effective 3/16 15

17. www.lewin.com Enhanced Options Counseling (EOC) Partners State of WI Department of Health Services, Bureau of Aging and Disability Resources GWAAR Zablocki VAMC Iron Mountain MI VAMC 16

18. www.lewin.com EOC Expansion 15 additional slots for veterans served out of Milwaukee VAMC, expanded to all counties in the catchment area 5 to 10 additional slots for veterans served out of Iron Mtn VAMC, where the veteran resides in WI. 17

19. www.lewin.com 18 Next Steps ACL/VHA will be holding quarterly educational calls ► 6/12/13 ► 9/18/13

20. www.lewin.com VD-HCBS Resources PowerPoint and Q&A will be posted on the ADRC-TAE webpage at: ► http://www.adrc-tae.acl.gov/tiki-index.php?page=vdhcbskey&filter=key http://www.adrc-tae.acl.gov/tiki-index.php?page=vdhcbskey&filter=key VD-HCBS Monthly Ticker: ► http://www.adrc-tae.acl.gov/tiki-index.php?page=vdhcbstickerentry http://www.adrc-tae.acl.gov/tiki-index.php?page=vdhcbstickerentry ACL Project Officer by State: ► http://www.adrc-tae.acl.gov/tiki-index.php?page=LewinTALeadsVDHCBS http://www.adrc-tae.acl.gov/tiki-index.php?page=LewinTALeadsVDHCBS 19