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VA Geriatrics

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VA Geriatrics & Extended Care National Update AGS May 4, 2006 VA GEC Strategic Planning GEC, PCS, VHA Budget Marsha Goodwin-Beck Awards Geriatric Research ... – PowerPoint PPT presentation

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Title: VA Geriatrics


1
VA Geriatrics Extended Care
  • National Update
  • AGS May 4, 2006

2
VA GEC
  • Strategic Planning GEC, PCS, VHA
  • Budget
  • Marsha Goodwin-Beck Awards
  • Geriatric Research, Education and Clinical
    Centers (GRECCs)
  • Geriatric Programs GEM Geri Prim Care
  • Geriatrics and Gerontology Advisory Committee
    (GGAC)

3
VA GEC
  • 7. Hospice Palliative Care
  • 8. Home-Based Primary Care and Medical Foster
    Home
  • 9. White House Conference on Aging

4
Eight for Excellence
  • Strategic Planning VHA, PCS, GEC
  • VHA Strategy 1 Continuously improve the
    quality and safety of health care for veterans,
    particularly those health issues associated with
    military service.
  • Initiative 1.5 Pursue innovations in services
    to aging veterans that enhance VA capabilities in
    long-term care, including care coordination and
    telehealth technologies.

5
Principle GEC Initiatives (part of PCS plan)
  1. Culture transformation of VA nursing home care
  2. Enhance access to non-institutional home and
    community-based services
  3. Affirm and enhance GRECC contributions to VHAs
    strategic initiatives
  4. Align and integrate chronic care within
    Geriatrics through a wider care coordination
    initiative

6
Additional GEC Initiatives
  1. Integration of new veterans with polytrauma into
    extended care programs
  2. Enhance veterans access to hospice and
    palliative care across all care settings
  3. Provide comprehensive coordinated care for
    veterans with dementia
  4. Improve primary care management of frail elderly
    veterans
  5. State Homes quality of care initiative
  6. Unannounced site survey program for VA NHCUs

7
  • 1. Culture Transformation of VA Nursing Home
    Care Transforming the current culture of nursing
    home care from a medical model, driven by medical
    diagnosis and illness, to a person centered
    culture of care whereby decisions regarding care
    and treatment involve the resident and are
    central to the organization and care processes in
    the nursing home.

8
  • 2. Enhance access to non-institutional home and
    community-based services, including care
    coordination/telehealth. Expand number of VA
    facilities offering HBPC and MFH, establish a
    national HBPC satisfaction survey, and conduct
    national survey to assess hospice and palliative
    care programs and services.

9
  • 3. Affirm and support Geriatric Research,
    Education, and Clinical Centers (GRECC)
    contributions to VHAs short-, medium-, and
    long-range plans for addressing the needs of
    aging veterans. Public Law 96-330 (1980)
    mandated Geriatric Research, Education and
    Clinical Centers (GRECCs) to advance scientific
    knowledge regarding the medical, psychological,
    and social needs of older veterans, and the means
    for addressing them, through (1) geriatric and
    gerontological research (2) the training of
    personnel providing health care service to older
    persons and (3) the development and evaluation
    of improved models of clinical services for
    eligible, older veterans.

10
  • 4. Align and integrate, where appropriate,
    chronic care within Geriatrics through a wider
    care coordination initiative. The VHA definition
    of Care Coordination is the use of health
    informatics, Telehealth and disease management to
    extend and enhance care and case management. The
    areas of Care Coordination include General
    Telehealth (CCGT) Home Telehealth (CCHT) Store
    and Forward (Teleretinal imaging). The scope of
    this initiative is to expand care coordination
    programs, increasing access to specialty care and
    to non-institutional care across the continuum.

11
Budget FY 2007 Proposal
  • More than 4.3 billion for LTC (increase of
    229M)
  • Institutional Care 3.8 billion
  • Non-Institutional Care 535 million (increase of
    48 million or 9.9)
  • State Home construction 85 million
  • State Home per diem 480 million

12
Marsha Goodwin-Beck Awards
  • 2005
  • Excellence in Leadership
  • John Morley, MB, B Ch
  • Director, St. Louis GRECC
  • Excellence in Clinical Care Delivery
  • Alison Bingman, MSN, APRN-BC
  • Nurse Practitioner at Durham VAMC
  • 2006
  • Pending

13
GRECC Updates
  • Updating performance measures
  • More relevant to VA, VISN, VAMC
  • Link to strategic plans
  • Re-examine/revise funding
  • Personnel
  • Educational, clinical projects
  • Research collaborations
  • Monthly CME-accredited audioteleconference series
    beginning 7/06
  • Annual Reports and Summary Report available at
    http//vaww1.va.gov/grecc/page.cfm?pg66
  • New Special Fellowships
  • All GRECC eligible
  • Open to non-MDs and non-geriatrician MDs
  • Request for eligibiilty for NIH Loan repayment
    Program

14
Geriatric Primary Care Updates
  • OK for piloting 5 measures based on ACOVE during
    summer 2006
  • End of life, funct. Assmt, UI screening and
    assmt, falls screening and assmt
  • Education of primary care providers in geriatrics
  • Strategic planning among GRECCs 5/2/06
  • DSS and Austin data analyses to support reduced
    geriatric primary care panel size
  • National Geriatric Primary Care/ACA meeting
    September 13-14, Philadelphia
  • Articulation of criteria for GEM Program of
    Excellence
  • Efforts to raise awareness and knowledge of
    delirium

15
Geriatrics and Gerontology Advisory Committee
  • 2005-2006 site visits
  • Pittsburgh, LA, St. Louis, Gainesville, Madison,
    Durham, San Antonio
  • New membership
  • White Paper submitted to Secretary
  • Non-institutional workload counting
  • GRECC support
  • Impact of VERA on clinical innovations
  • Follow-up from Mill Act pilots

16
Hospice Palliative Care (HPC)
  • Dr. Scott Shreve is our National Director of HPC
  • Survey on VA Palliative Care services completed.
    Distributed to VISN CMOs past week.
  • Annual Report for FY2005 distributed.
  • Vision for VA End of Life Care

17
Actions to improve care
  • Partnering
  • - Hospice-Veteran Partnerships
  • - Acute care (recruiting partners)
  • Raise Expectations (reduce variability)
  • - Reporting variation
  • - Targeting program development
  • Accountability
  • - Outcome measure implementation
  • - Request For Proposal Initiative (seed money)
  • Enhanced Expertise
  • - Audio conferences, face to face and online
    curricula
  • - AACT Little Rock May 23-25 Kansas City
    July 25-27

18
VA-Paid Home Hospice Care
Average Daily Census
19
of Inpatient VA Deaths with a Palliative Care
Consult
20
Palliative Care in VA Home-Based Primary Care
(HBPC)
of veterans served with v66.7 code
21
Home-Based Primary Care
  • Expansion 74 to 105 programs ADC 8081 to
    11,063 keep pushing
  • Performance Measure both ADC and
  • 6 of 9 HCBC programs at all facilities
  • Challenges to HBPC at every site
  • Misperception that HBPC similar to Medicare
  • Perception that HBPC is too costly
  • Lack of awareness of benefits to veterans and
    facilities

22
VACO Support for HBPC
  • Encourage HBPC at all facilities
  • VACO support
  • National cost analysis 24 net cost avoidance
  • Demographic analysis of anticipated population
    need for HBPC
  • Proposal guidance
  • Mentor for HBPC Program Director and HBPC Medical
    Director

23
What is Medical Foster Home?
  • Alternative to nursing home placement for
    veterans who can no longer live alone and have no
    caregiver
  • Merges adult foster home with VA Home-Based
    Primary Care (HBPC)
  • VA helps find a person in the community who will
    take a dependent veteran into their private home
  • MFH caregiver provides daily personal assistance
    and supervision
  • VA HBPC provides comprehensive medical care and
    management caregiver education
  • VA MFH Coordinator provides oversight
  • Veteran pays for MFH

24
What is Medical Foster Home?
  • Partnership of Foster Care with HBPC
  • Alternative to nursing home placement for
  • - dependent, chronically ill, or terminally
    ill veterans
  • - unable to live independently, and
  • - prefer a family setting for their long-term
    care.
  • Average age 72yrs Number of major
    problems 8
  • Prominent Dx Dementia, CVA, Heart Disease,
    COPD
  • All eligible for nursing home care
  • VA finds caregivers provides oversight and HBPC
  • Foster care costs paid by veteran, from VBA

25
How did MFH start?
  • Two social workers at Little Rock VA
  • Problem Veterans in HBPC declined and could no
    longer live alone, refused NH
  • Opposing ethical principles
  • Unsafe at home, or force out of home?
  • Solution find a willing caregiver, meet medical
    care needs through HBPC
  • Pilot 2002 cautiously optimistic success

26
Target Population for MFH
  • Eligible veterans who
  • Are unable to live independently due to
    functional, cognitive, and/or psychiatric
    impairment chronic or terminal illness
  • Have no suitable caregiver to provide needed
    monitoring, supervision, and assistance
  • Meet nursing home criteria
  • Have complex medical conditions requiring care
    from an interdisciplinary team and
  • Are able to pay for MFH (VBA SS)

27
Risks of MFH
  • Potential for abuse and neglect
  • Caregiver selection background Long-term
    commitment Work will increase over time
  • Accept unannounced visits
  • Oversight (similar to Community Residential Care)
  • VA liability concerns for veterans and caregivers
  • Manage similar to Community Residential Care
  • Cost to VA
  • Experience lowers cost to VHA, because some 70
    SC veterans choose MFH. Cost neutral for VA.

28
Benefits of MFH
  • VA offers an option to NH care, in a less
    restrictive environment
  • Veteran can choose a home environment
  • MFH less costly than nursing home
  • For 70 SC veterans, cost savings to VA
  • Net savings to VA facility in current year
  • Benefits to caregivers
  • Benefits to community

29
Medical Foster Home Expansion
  • View video VISN libraries and HBPC programs
  • Training program in July 2006
  • Preliminary inquiries sent last week to all HBPC
    Program Directors
  • MFH Program Guide draft completed
  • Contact thomas.edes_at_va.gov

30
2005 White House Conference on AgingFrom
Awareness to Action
  • VA GEC Update

31
Update on WHCoA
  • Implementation strategy highlight report
  • Letters to Governors
  • Responses from Governors
  • www.whcoa.gov look at News for Speakers and
    Presentations and Input from Governors
  • Working on Final Report

32
Choose your favorites
  • Resolution 48 Ensure Appropriate Recognition
    and Care For Veterans Across All Healthcare
    Settings.
  • Resolution 42 Promote Innovative Models of
    Non-Institutional Long-Term Care

33
Choose your favorites
  • Resolution 40 Attain Adequate Numbers of
    Healthcare Personnel in All Professions Who are
    Skilled, Culturally Competent, and Specialized in
    Geriatrics.
  • Resolution 32 Evaluate Payment and Coordination
    Policies in the Geriatric Healthcare Continuum to
    Ensure Continuity of Care.
  • Resolution 34 Improve The Health And Quality Of
    Life Of Older Americans Through Disease
    Management And Chronic Care Coordination.

34
Update on WHCoA
  • Encourage collaboration and participation
  • Contact your Governor identify priorities
  • Work with AGS
  • Work with Area Agency on Aging state, county and
    local organizations
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