VA Maryland Health Care System: Geriatrics & Long Term Care

1. VA Maryland Health Care System:Geriatrics & Long Term Care Non-Institutional Community Care Programs

2. Community Adult Day Care Program • Must be enrolled in the VA Healthcare System • Seen by VA Primary Care Provider at least yearly • Can attend a community ADC up to two days a week at VA expense • Veteran can choose ADC from selection of centers that have a contract with the VA • Complete a 10-10EC VA Extended Care Services form (financial information ) yearly • Copay of 15.00 a day if Veteran is in Priority Group 8 • Once in program, VA pays indefinitely

3. Home Health Aide Program • VA can fund up to 10 hours per week of home health aide services through a contract with a community home health agency • Veteran must be enrolled in VA and seen by VA primary care provider at least yearly • Needs help in three or more activities of daily living (ADL’s) such as dressing, bathing, elimination, transfers, and has cognitive impairment,or • Needs help in two ADL’s with one of the following; recent discharge from a nursing home, 75 or older, clinical depression, living alone • Requires aide care as adjunct to hospice care • Copay of 15.00 a day if Priority Group 8 • Currently a waitlist for this program, except for veterans under home hospice care

4. Inpatient Respite Program • Veterans are eligible for 30 days of respite per year (inpt at VA, a community Nursing Home under VA contract, or in-home respite) • Acceptance for inpt respite is based upon bed availability at Loch Raven or Perry Point facilities at time of respite request • Respites should be requested 6 months in advance (exception for emergency respites). Length of respite has to be at least one week • Must complete10-10EC form prior to admission to determine copay eligibility. May have a copay after the first 21 days of respite. Copay for inpt respite is up to 97.00 a day (sliding scale) based on income/assets/nonreimbursed medical expenses • Need to have chest x-ray, TB Gold or PPD completed within one year of date of admission • Must be out of the hospital at least 30 days prior to admission for respite • Bring a list of medication and advance directives upon admission • Paid caregivers are not eligible for respite

5. In-Home Respite • Enrolled in the VA and following in Primary Care Clinic or by VA provider • Caregiver is in need of temporary or intermittent relief from day to day care. • Allowed up to 30 days a year (could be in combination with inpatient respite) , in one-week increments. • Each day of in-home respite consists of up to 6 hours per day of aide care • 10-10EC completed to determine if Veteran is responsible for copay ($15 per day) • This is for short term help and not for a referral for long term aide care • Referral can be made through VA primary care social worker

6. Contract Nursing Home Program • 32 day contract available for Non-Service Connected Veterans who are inpatient at VA and are discharged to CNH • Indefinite contract available for Veterans 70 % or more Service Connected • Indefinite contract available if veteran is in Nursing Home for SC diagnosis • Respite placement at a CNH if there are no available beds at a VA facility, for no more than 30 days (may have copays after first 21 days)

7. Home Based Primary Care HBPC

8. What is the Home Based Primary Care Program (HBPC)? • Direct Care Program: Enables veterans to remain in the home while receiving comprehensive healthcare at home • Provides all Primary Care follow up • Social Work assessment for supportive services available through VA and community resources • Assess home safety, need for durable medical equipment and arrange for delivery of equipment to home • Other Benefits: Reduced number of hospitalizations and length of stay for hospital admissions

9. HBPC: Health Care Services • Primary care in the home • Available On-Call for nights, weekends, holidays • Regularly scheduled NP/RN visits • Health Exams • Teach caregiver about home health care, skin care, medication management, preventing caregiver stress

10. Who is the HPBC Team? • Program Manager • Nurse Practitioners • RN’s • Social Workers • Kinesiotherapist (Equipment Therapist) • Psychologist • PharmD • Physicians • Program Support Assistants

11. HBPC: Other Benefits • Usually no cost to veteran • Assistance with transportation to VA facilities (if eligible for VA Travel) • Patient/caregiver education and support • Referrals to community agencies for skilled services: wound care, PT, OT

12. HBPC: What Areas are Served • Baltimore City/County • Anne Arundel • Harford • Cecil • Carroll • Howard

13. HBPC: Referral/Eligibility • Must have established eligibility for VA Health Care • Outside referrals can be made by Veteran, family members, community agencies, health providers • Veteran must be unable to travel to, or easily get to the VA Outpatient PCC, usually due to chronic/multiple health issues • Nurse Practitioner will visit home to perform initial assessment within 15 working days • Case is presented at weekly staff meeting to determine whether veteran meets program criteria for acceptance into HBPC

14. HBPC Contacts • Richard Troy, Program Manager 410-605-7622 • Office Nurse (referrals) 410-605-7639 • David Berman, LCSW-C410-605-7640 • Stacy Heinze, LCSW-C 410-605-7623

15. Hospice and Palliative Care Hospice care is now part of the basic eligibility package for all Veterans enrolled in the VA. If hospice care is needed and other funding is not available, the VA will either provide hospice care directly or will purchase it from community hospice agencies.

16. Inpatient Hospice • Screening Committee reviews hospice/palliative care admission. • Must meet criteria for hospice • Placed in available beds at Loch Raven or Perry Point facilities. • No copays for hospice admissions.

17. Referrals for LTC programs: Inpatient Respite, Inpatient Hospice, CNH/Rehab • Screening Committee meets daily at 1PM • Referral information must be submitted by 11AM to be considered that day • All referrals need a Discharge Summary/H&P • Referrals must be out of Intensive Care Units for 24 hours and no telemetry before admission to LTC

18. Referral to Long Term Care Screening Community Referrals are sent to: Nicole Trimble Phone 410-642-2411 ext 6353 Fax 410-642-1192

19. Assisted Living (AL) or Community Residential Care (CRC) • CRC’s are AL homes in the community that have VA oversight. All homes are VA approved and Md state licensed • CRC costs are paid privately by veteran and /or family. VA provides regular RN visits and monthly SW visits • Veteran must meet guidelines for AL levels of care • Veteran/family must complete all VA and state referral paperwork • Veteran must agree to rules and regulations of home • Veteran will be followed in VA Primary Care Clinics

20. VA Assisted Living (CRC) Referrals • Deborah Qualls, LCSW-C, CRC Program Coordinator • Phone 410-642-1721

21. Emergency Alert Response System • Referral by VA Primary Care • Consult forwarded to HBPC • Alert system mailed to Veteran • Alert system is compatible with 911 system

22. Applying for VA Healthcare Benefits Served active military, naval, or air service with honorable discharge Complete 10-10EZ Application for Health Benefits and mail/fax to VA Enrollment Center Include DD-214 Report of Military Separation If approved for enrollment, assigned to a Priority Group (based on SC disabilities, former POW, Purple Heart, VA Pension, income) Schedule a visit with a VA primary care provider

23. VA Income Thresholds for 2011 • Free VA Prescriptions and travel benefits (maximum allowable rate): A • Free VA Health Care: (0% service connected {noncompensable} and nonservice-connected veterans only): B A B • 0 dependents $11,830 or less $29,402 or less • 1 dependent $15,493 or less $35,284 or less • 2 dependents $17,513 or less $37,304 or less • 3 dependents $19,533 or less $39,324 or less • 4 dependents $21,553 or less $41,344 or less • For each additional dependent add: $2,020 $2,020 • Income & Asset Net Worth: $80,000

24. Enrollment Restriction:In order to ensure the availability of quality and timely health care to veterans with service connected conditions, special authority based on military service, low income, and those with special health care needs, in January 2003 VA made the difficult decision to stop enrolling new Priority Group 8 (high income) veterans whose income exceeded VA Income Thresholds. The new regulations went into effect on June 15, 2009 and enable the Department of Veterans Affairs (VA) to relax income restrictions on enrollment for health benefits. While this new provision does not remove consideration of income, it does increase income thresholds. You may be eligible for enrollment under this new provision. • For more information on VA Healthcare Eligibility/Enrollment , go to: • www.va.gov/healtheligibility/ OR call • 1-877-222-8387 (VETS)

25. THANK YOU FOR YOUR SERVICE TO OUR COUNTRY!!!