James Hallenbeck, MD Associate Chief of Staff, Extended Care, VA Palo Alto Health Care System, Associate Professor, Stanford University james.hallenbeck@va.gov.

James Hallenbeck, MDAssociate Chief of Staff, Extended

Care, VA Palo Alto Health Care System,

Associate Professor, Stanford University

james.hallenbeck@va.gov

California Veterans2.2 Million (6%) of California population

Of these…94% men, 6 % women35% of veterans are > age 65 (10.6 % overall

pop. > 65)21% of Californians > 65 are veterans> 60% of Californian men > 65 are

veterans

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

Think of the VA when…• Special clinical needs

– Related to military service– Mental Health issues/PTSD

– Needs adjunctive care to stay at home– Homelessness– Blind

• Concern about benefits

VA FacilitiesHave discrete catchment areasAssociated 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.

EligibilityPrioritization of veterans with Service-

Connected DisabilitiesDiffering eligibility standards for

Outpatient/Home/Acute care and Nursing Home CareOutpatient/acute: basic eligibilityLong Term Nursing Home: highly SC only

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

Example: Hospice CareVA Hospice Benefit – mimics MedicareEspecially useful for veterans <65 without

MedicareFor enrolled veterans as ordered by a VA

providerNot intended for un-enrolled veterans calling a

VA facility to get them to cover care

Home Care ServicesHome-based Primary Care (HBPC)

Homebound, VA primary care provided at home, geographically restricted areas

Homemaker/Home Health Care (H/HHA)Very similar to IHSSPurchased from community agencies

Contract Adult Day Care (CADHC)

Note: VA largely blind to parallel services, such as IHSS

Home Care ServicesPurchased 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 programVeteran Directed Care

Unlike Medicare, all purchased VA home care prospectively authorized

Nursing Home CareVA Nursing Homes (Community Living

Centers, CLCs)Short-stay rehab/post hospitalLong term care for highly 60% + SC veterans

Community Nursing Home (CNH) program

ChallengesTwo-way lack of knowledge

Community organizations do not understand VAMany VA providers equally ignorant of

community resources

Common complaint about VA – don’t know who to talk with/ poor contact information.

The Great MythCare of veterans the sole responsibility of the

VAReality: 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

SuggestionsIncorporate routine inquiry regarding

veteran status into assessmentsAssess enrollment status, service-connectionIf enrolled – which VAMC

Become familiar with unique VA services and where VA can “plug holes”

Special VA ServicesSome Home Care ServicesSpinal Cord InjuryMental Health Services

PTSD, Substance abuseCare for Homeless Veterans (residential

programs, HUD/VASH (voucher) programHospice/palliative careBlind rehabilitation programs

Cultivate Your Contacts at Local VAMCs!

Admissions and EligibilityCaregiver Support ProgramHome CareGeriatrics and Extended CareHomeless Veteran Program CoordinatorsPatient AdvocateVeteran Service OfficersADRC points of contact

Note: Quality of facility websites- variable. When in doubt, call

program offices

SummaryVA 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!