1. A Quick Primer on “the VA” for ADRCs
James Hallenbeck, MD
Associate Chief of Staff, Extended Care,
VA Palo Alto Health Care System,
Associate Professor, Stanford University

5. California Veterans Of these…
2.2 Million (6%) of California population
Of these…
94% men, 6 % women
35% of veterans are > age 65 (10.6 % overall pop. > 65)
21% of Californians > 65 are veterans
> 60% of Californian men > 65 are veterans

6. Think of the VA when…
A veteran tells you that he/she is enrolled at a particular VA facility
Funding difficulties – ineligible for Medicare, MediCal and no private insurance
Military/Veteran-related issues arise

7. Think of the VA when… Special clinical needs Concern about benefits
Related to military service
Mental Health issues/PTSD
Needs adjunctive care to stay at home
Homelessness
Blind
Concern about benefits

8. A Deeper Dive into VHA

9. VA Facilities
Have discrete catchment areas
Associated Clinics (Community Based Outpatient Clinics – CBOCs)
Veterans enrolled at a particular facility
Encouraged to have primary care provider
VA Medical Centers function much like a managed care organization like Kaiser.

10. Eligibility
Prioritization of veterans with Service-Connected Disabilities
Differing eligibility standards for Outpatient/Home/Acute care and Nursing Home Care
Outpatient/acute: basic eligibility
Long Term Nursing Home: highly SC only

11. Is VA Care a Form of Insurance?
Yes and No
Yes: for enrolled veterans receiving VA through VA (like Kaiser)
Yes: for some care for highly service-connected veterans outside VA (acute care hospitalizations)
No: For most other types of care outside the VA

12. Example: Hospice Care VA Hospice Benefit – mimics Medicare
Especially useful for veterans <65 without Medicare
For enrolled veterans as ordered by a VA provider
Not intended for un-enrolled veterans calling a VA facility to get them to cover care

13. Home Care Services Home-based Primary Care (HBPC)
Homebound, VA primary care provided at home, geographically restricted areas
Homemaker/Home Health Care (H/HHA)
Very similar to IHSS
Purchased from community agencies
Contract Adult Day Care (CADHC)
Note: VA largely blind to parallel services, such as IHSS

14. Home Care Services Purchased Home Care
Skilled nursing care at home (like Medicare Home Care)
Hospice Care (similar to Medicare)
Spinal Cord Home Care (by VA providers)
Emerging programs:
Medical Foster Home program
Veteran Directed Care
Unlike Medicare, all purchased VA home care prospectively authorized

15. Nursing Home Care VA Nursing Homes (Community Living Centers, CLCs)
Short-stay rehab/post hospital
Long term care for highly 60% + SC veterans
Community Nursing Home (CNH) program

16. Challenges Two-way lack of knowledge
Community organizations do not understand VA
Many VA providers equally ignorant of community resources
Common complaint about VA – don’t know who to talk with/ poor contact information.

17. The Great Myth Care of veterans the sole responsibility of the VA
Reality: only 26% of veterans cared for by VA in any given year
Many of these veterans receive only some of their care through VA
Given this, optimal care for veterans requires collaboration between VA and community organizations

18. Suggestions
Incorporate routine inquiry regarding veteran status into assessments
Assess enrollment status, service-connection
If enrolled – which VAMC
Become familiar with unique VA services and where VA can “plug holes”

19. Special VA Services Some Home Care Services Spinal Cord Injury
Mental Health Services
PTSD, Substance abuse
Care for Homeless Veterans (residential programs, HUD/VASH (voucher) program
Hospice/palliative care
Blind rehabilitation programs

20. Cultivate Your Contacts at Local VAMCs!
Admissions and Eligibility
Caregiver Support Program
Home Care
Geriatrics and Extended Care
Homeless Veteran Program Coordinators
Patient Advocate
Veteran Service Officers
ADRC points of contact
Note: Quality of facility websites- variable. When in doubt, call program offices

21. Summary
VA provides excellent healthcare – with some benefits not readily available through the community
Navigating the VA labyrinth can be challenging
It is all about relationships and communication
Together, we can do a better job serving those who have served!