1. Home Health Options in the VA

2. Home Based Primary Care
In place of a clinic visit to a primary care physician (will describe LR model)
Interdisciplinary in nature
Joint Commission accredited

3. Patient Characteristics (1)
Homebound
Frail with chronic medical problems
Accepting of care
Generally geriatric

4. Patient Characteristics (2)
Avg age is 80
Medical problems avg 12-20
Cognitive Impairment of some degree is prevalent
If spouse is caregiver, also frail with cognitive impairment
Avg income $20,000
Youngest patient 23---oldest 102
As many as 30 problems

5. Patient “Qualifications”
Meet the characteristics
Live in geographic territory
Don’t drive
Have a caregiver
Have a habitable home
Safe environment---substance abuse, violent
neighborhood

6. Refferals Formal consults Informal consults
Inferred through other needs
Self referrals
Other patients/caregivers refer

7. Process Evaluation---SW, Psychologist, APN
Needs can be met by team resources
Patient agrees to limit outside providers
All team members assess the patient
Treatment Plan is developed in an interdisciplinary team meeting

8. VA Health Care Team APN RN SW Psychologist Therapist RD Pharmacist
Medical Support Clerk
Physician
PATIENT/CAREGIVER

9. Medical Foster Homes Piloted in Little Rock---Judy Karklins, LCSW
Adopted as national program
Patients must be followed by HBPC
Veteran pays for room/board/physical care on a scale according to ADL needs
VA vets the homes for safety/suitability

10. MFH (2) Non-institutional care “Age In Place” Family atmosphere
Sufficient Income
Same criteria as for HBPC
Based on Medicaid Waiver program of Oregon to try and decrease NH placements. Not as regulated as ours---no asso health care team. Money to pay is most often from getting Veteran benefits from filing for pensions---can be private pay
Problems occur when only source of income for the caregivers/sponsors. Back ground checks.

11. Fee Services
Home Health Aides
Skilled Nursing Service
Hospice
Therapy

12. Process for Fee Service
Order Alert to Community Health Division of HHCS
CHN contacts Fee Office for fee payment approval
Fee physician approval of care
CHN locates agency in Veteran’s area who has availability and faxes orders, pertinent clinical data and fee authorization for payment to agency