Improving long term care for our nations Veterans - Research Paper Example

?Table of Contents Introduction………………………………………………………………………………… 2 Background ………………………………………………………………………………… 3 Current strategy …………………………………………………………………………….. 5 Brief description of alternative scenarios and associated risks……………………………… 9 Executive summary …………………………………………………………………………. 10 References……………………………………………………………………………………. 12 (name) (professor) (subject) (date) Improving Long Term Care for Our Nation’s Veterans Introduction Veterans are heroes returning from war. During their return, it is almost always the case that they would be suffering from the physical or psychological trauma of the war. As such, they carry wounds, disabilities, and psychological issues which impact negatively on their daily activities. Due to their limited financial options, their access to quality healthcare is often compromised. This is an unfortunate circumstance considering the fact that many veterans suffer from long-term conditions and disabilities. With financial issues and insufficient long-term care plans for veterans, there is a need to conceptualize a comprehensive and strategic care plan for veterans. This paper is being carried out in order to establish a viable and comprehensive 3-5 year strategic care plans for veterans. This topic was chosen because it is highly relevant in this current healthcare system and because there are no existing plans for these veterans. A background of this issue shall be presented, including an assessment of the current organization, as well as the political, organizational, economic, financial, and technological environment for veterans. This background basically presents an assessment of the organization. A current strategy shall also be presented, including current vision, goals, objectives, philosophy, culture, and strategies for major functional areas. A brief description of alternative scenarios will also be discussed. Finally alternative strategies and recommendations in current posture and processes in order to meet the challenges of the changing environment will be considered by this paper. Background Current trends: Healthcare for military personnel, including veterans and active duty members spans a wide range of programs under the control and management of the Department of Defense (DoD) and the Department of Veteran Affairs (Kaiser). TRICARE is the primary health care program for active duty soldiers and veterans, including their families. This program covers three health coverage plans: the TRICARE Prime, TRICARE Extra, and the TRICARE Standard or CHAMPUS. The differences in these three plans mostly are in the eligibility, providers, and out-of-pocket costs (Kaiser). TRICARE for Life (TFL) covers Medicare-eligible military retirees and their family as well as their survivors. And in instances when both Medicare and RFL apply, Medicare takes precedence over TFL coverage. The Veterans Health Administration (VHA) covers and delivers health care to the veterans as well as their families (Kaiser). It also manages the largest integrated health system which covers millions of inpatients and outpatients veterans based on a wide network of hospitals and interworking systems of clinics, rehabilitation programs, residential programs, and nursing homes (Kaiser). The veterans are usually assigned to eight levels of prioritization, based on their service-connected injuries, income, and on other similar factors. Based on these considerations, the Secretary of Veterans Affairs often determines if the budget for veteran healthcare is adequate to meet the needs of the veterans requiring care (Kaiser). The VA is available to all veterans, especially those who are uninsured and who have low incomes (Military Handbooks, p. 4). Despite its availability, about 1.8 million veterans under 65 years do not have health insurance or access to Veterans Affairs hospitals, and these uninsured veterans are even considered in the lowest priority group for Veteran healthcare; and others who are eligible may live far away from the VA health centers (Kaiser). Nevertheless, the VA provides a standard Medical Benefits Package to all enrolled veterans; and their health services include primary care as well as inpatient and outpatient health services (Kaiser). For those with high priority status, the VA also ensures dental services, nursing home care, and rehabilitation services, especially for those who are physically disables and those who need mental health care. Strengths The Department of Veterans Affairs also specifies three kinds of long-term health services available for veterans. The first kind refers to the benefits for veterans who suffered disabilities related to their service (Long-term care). Services for these veterans include home care, assisted living, geriatric assessments, and nursing home care. These veterans have the highest priority in health enrollment acceptance. These types of services may also be given to veterans with low incomes even if their disabilities are not related to their military service (Long-term care). The second type of benefit is related to state veteran homes where the VA would help build and support state veteran homes through monetary assistance from the federal government. For those in nursing homes, a subsidy of $67.71 a day is available. Nursing home care services are also available in relation to assisted living and adult day care (Long-term care). The third type of benefit for veterans under long-term care is disability payments. This would include compensation, pension, and survivors’ death benefits. Compensation is considered the veterans’ monthly income, and is meant to serve as replacement for the veterans’ loss of income in the private sector due to his disability in the service. This amount is based on the percentage of disability when the veteran left the military service (Long-term care). This compensation may also be allocated based on their recorded exposure to extreme cold or non-disabling injury, as well as tropical diseases which may manifest later or which may worsen later in their life. Pension is also given to veterans who served at least 90 days in service (Long-term care). There is no need for these veterans to suffer any disability to be entitled to pension. Monetary assistance as well as health services is therefore available for all veterans. Threats: In the current context however, limitations in financial allocations have led to various issues in health services availability and access. Moreover, the difficulty of transitioning these veterans into normal civilian life has always been a major issue for the government (Panangala, p. 13). Current strategy: Vision: The current vision for veterans’ health is to improve its quality, access, and coverage for all veterans with long-term conditions. Goal 1: Achieve Five-star quality rating in the Centers for Medicare and Medicaid Services by 2014 in all Veterans Hospitals. Activities: In order to achieve this goal, there should be a strict adherence to the regulatory standards of care (Agency of Human Services, p. 2). This would include submitting to multidisciplinary reviews for the hospitals and for the health care givers. These reviews and strict application of regulations would ensure that state veterans would receive the best possible care, one which is properly monitored through policy alignment, process, alignment, best programs and practices, standard reimbursement processes, staff productivity analysis, standardized education, and information integrity (Department of Veteran Affairs, p. 5). Firstly, policy alignment would include developing policies in line with the goals in achieving five-star quality health care. An audit program can be used in order to regularly review policy compliance (Department of Veteran Affairs, p. 5). Secondly, process alignment would include redesigning and standardizing hospital interventions, assessment, admissions, and forms processes in order to meet regulatory, as well as safety standards for the hospital and its personnel. Thirdly, the five-star rating can be reached by applying best practices and programs in the delivery of long-term care to veterans (Department of Veteran Affairs, p. 5). Fourth, standard reimbursement policies are meant to gather all reimbursements from Medicare, Medicaid, VA, and private insurance and maximize their impact on the patient. The fifth method by which the five star quality rating of veterans centers can be reached is to improve the staffing of the various centers. This would mean the establishment of audit controls for the staff, reviewing and assessing their actions and interventions and noting whether or not they meet the standards of care (Department of Veterans Affairs, p. 5). Still another means of improving standards and quality would be to implement a more standard education in terms of training health professionals in caring for patients, especially the veterans with long-term illnesses. Finally, guaranteeing information integrity would eventually promote quality health care for long-term care veterans. Information integrity would also involve the process of implementing audit activities in order to promote system-wide information dissemination, as well as accurate and accessible data access (Department of Veterans Affairs, p. 5). Goal 2: To promote independent and patient-based care for veterans Opportunities: Independent living is still the best care for long-term veterans because it provides them with more comfort and control over their activities (Kinosian, p. 4). It also helps ensure that a more patient-centered care is implemented for the patient. Independent living includes supported housing, combined with case management and independent community living (Carling). This remedy would also provide a stable housing which is often an essential requirement in mental health care and substance abuse treatment (Lapham, Hall, and Skipper). This remedy would provide stable and independent residence after entry into the program; and treatment compliance need not be made a condition of housing. In order to make this project feasible, financial support is needed. Financial support can be ensured through the rental assistance program, which is under the Department of Housing and Urban Development (HUD). This program has been known to provide housing assistance for those who are in dire need (Kasprow, et.al.). In applying under this program, vouchers can be used in order to support a person’s qualification under this program. Rental subsidy for these long-term care veterans can be provided under the HUD-VA (Kasprow, et.al.). The subsidy shall be based on the local fair market rental rates as well as the veterans’ personal income, including his pension. This subsidy shall cover the fair market rental value which shall exceed the veterans’ personal income. For those with no existing income, their rate can be covered fully. Renegotiation of these terms can be made every 12 months, depending on changes in the veterans’ income (Kasprow, et.al.). Case managers covering veterans under the HUD-VA are also tasked with providing client monitoring and support. They are also tasked with maintaining active liaisons with the local housing representatives in order to ensure that the rents of the veterans are paid on time and that the veterans are safe and secure in their units (Kasprow, et.al.). Independent living under these rented units is based on referrals from VA’s national homeless outreach program, as well as the Healthcare for Homeless Veterans program (Kasprow, et.al. p. 56). Applications for rental subsidies are then evaluated by multidisciplinary admissions committees to establish the appropriateness of the veterans’ coverage under this program. These veterans also have to undergo a comprehensive psychological and sociological evaluation in order to highlight problem areas and to review specific long-term as well as short-term goals in their health improvement (Kasprow, et.al.). This assessment shall also seek to establish the physical condition of the veteran, including his disability and needs, as well as the adjustments which can be made on his rental home. This may include the installation of ramps, of lower counters, of handrails, and of similar adjustments for those using wheelchairs, those with any amputated limbs, or those with any other physical disabilities. Building networks with the nearest hospital, clinics, and outpatient centers, is also an important duty for the task managers who must ensure that the veterans are aware of these centers, including the numbers they need to call during emergencies. Goal 3 Financial allocation to cover live-in personnel or monitoring medical personnel Opportunities: The federal government as well as the Veterans Affairs, including the Medicare must also set aside allocations for veterans’ live-in personnel. Based on the conditions of long-term care veterans, many of them may actually need live-in assistance or may require regular visits form medical personnel. Since many veterans cannot afford such personnel, financial assistance can be set aside for those who have the greatest need and those who would benefit the most from assisted living personnel. These veterans must however still be able to live independent lives, otherwise, they may not qualify for assisted living. In effect, these patients must be able to carry out their activities of daily living with relative independence; they must be mobile and able to navigate through their living quarters independently; they must be able to secure medical care independently; they must be able to voluntarily carry out bowel movements and urination independently; they must also be able to carry out minor maintenance activities for their housing units; and they must be able to independently leave their facility in case of an emergency (Kansas Veteran’s Home, p. 7). If they are not able to carry out these functions, then they have to be admitted into nursing homes for appropriate focused care. Under assisted living in their rental units or home settings, they would be able to access nutritious meals which are specifically meant for each individual patient’s needs (Kansas Veterans’ Home, p. 1). They would also be entitled to transportation services to and from the health clinics for their regular or emergency consultations. Security shall also be provided in these units with 24 hour patrols within the facilities and housing units (Kansas Veteran’s Home, p. 1). Health staff assigned to monitor the patients must also be adequately trained to meet the needs of the veterans and to provide health education for the residents, including their families. A medical clinic shall also be made available within easy reach of these units. Activity rooms and gyms must also be made available for the veterans. This would provide them with entertainment as well as leisure spots for sports and socialization activities. Brief description of alternative scenarios and associated risks Weaknesses: Alternative scenarios for veterans include discussions with regional and provincial health authorities on ways to quickly identify veterans among those seeking access to long-term facilities. This may include a box on the application forms where they can indicate that they are veterans (Veterans Affairs). In this case, the ability to choose which services they may receive would be placed on the veteran. Weaknesses in this case would be related to the abuse of the opportunity. The choice of identifying access to long term care is placed on the veteran. The veteran may abuse such discretion and seek long-term care when he may not actually need it. Another alternative in long-term care would include the development of guidelines in the construction and renovation of dining areas to ensure wheelchair accessibility and provide a more home-like atmosphere for these veterans (Veterans Affairs). Although this provides long-term benefits for veterans, it is also a very costly venture for the government which is already financially compromised in terms of its allocations for the delivery of health care services. There are major risks for the government to consider in implementing these changes and in allocating costs to accommodate these adjustments in long-term care facilities and residences. Executive summary Vision: The current vision for veterans’ health is to improve its quality, access, and coverage for all veterans with long-term condition. Goal 1: Achieve Five-star quality rating in the Centers for Medicare and Medicaid Services by 2014 in all Veterans Hospitals. Strict adherence to the regulatory standards of care. This would include submitting to multidisciplinary reviews for the hospitals and for the health care givers. 1. Firstly, policy alignment would include developing policies in line with the goals in achieving five-star quality health care. 2. Secondly, process alignment includes redesigning and standardizing hospital interventions, assessment, admissions, and forms processes in order to meet regulatory, as well as safety standards for the hospital and its personnel. 3. Thirdly, the five-star rating can be reached by applying best practices and programs in the delivery of long-term care to veterans 4. Fourth, standard reimbursement policies are meant to gather all reimbursements from Medicare, Medicaid, VA, and private insurance and to maximize their impact on the patient. 5. Improve the staffing of the various centers. This would mean the establishment of audit controls for the staff, reviewing and assessing their actions and interventions and noting whether or not they meet the standards of care 6. Implement a more standard education in terms of training health professionals in caring for patients, especially the veterans with long-term illnesses. 7. Guaranteeing information integrity would eventually promote quality health care for long-term care veterans. Goal 2: To promote independent and patient-based care for veterans Independent living includes supported housing, combined with case management and independent community living. Financial support can be ensured through the rental assistance program, which is under the Department of Housing and Urban Development (HUD). Rental subsidy for these long-term care veterans can be provided under the HUD-VA Goal 3 Financial allocation to cover live-in personnel or monitoring medical personnel The federal government as well as the Veterans Affairs, including the Medicare must also set aside allocations for veterans and live-in personnel. These patients must be able to carry out their activities of daily living with relative independence; they must be mobile and able to navigate through their living quarters independently; they must be able to secure medical care independently; they must be able to voluntarily carry out bowel movements and urination independently; they must also be able to carry out minor maintenance activities for their housing units; and they must be able to independently leave their facility in case of an emergency Under assisted living or domiciliary care, they would be able to access: nutritious meals which are specifically meant for each individual patient’s needs; transportation services to and from the health clinics for their regular or emergency consultations; security; health staff assigned to monitor them; a medical clinic; activity rooms and areas for entertainment as well as leisure spots for sports and socialization activities. Brief description of alternative scenarios and associated risks Alternative scenarios for veterans also include discussions with regional and provincial health authorities on ways to quickly identify veterans among those seeking access to long-term facilities. This would include a box on the application forms where they can indicate that they are veterans. Risks in this case would be on abuse. The choice of identifying access to long term care is placed on the veteran. The veteran may abuse such discretion and seek long-term care when he may not actually need it. Another alternative in long-term care would include the development of guidelines in the construction and renovation of dining areas to ensure wheelchair accessibility and provide a more home-like atmosphere for these veterans. Although this provides long-term benefits for veterans, it is also a very costly venture for the government which is already financially compromised in terms of its allocations for the delivery of health care services. Works Cited Agency of Human Services. ‘Task Force - Long-Term Care Service Needs Of Vermont Veterans, Vermont’. 2012. Web. 22 March 2012 Carling, P.J. ‘Housing and supports for persons with mental illness: emerging approaches to research and practice’. Hospital and Community Psychiatry. 44 (1993): 439-449. Print. Department of Veterans’ Affairs. ‘Strategic Plan’. 2010. Web. 22 March 2012 Kaiser Edu. ‘Military and Veterans’ Health Care’. 2012. Web. 22 March 2012 Kansas Veterans Home. ‘A place of honor’. 2011. Web. 22 March 2012 Kasprow, W.J., Rosenheck, R., Chapdelaine, J.D. et.al. ‘Health Care for Homeless Veterans Programs: The 12th Annual Report’. West Haven, Conn, VA Northeast Program Evaluation Center. 1999. Print. Kasprow, W., Rosenheck, R. and Frisman, L. ‘Referral and Housing Processes in a Long-Term Supported Housing Program for Homeless Veterans’. Psychiatric Services, 51(8). (2000). Print. Kinosian, B. ‘The Department of Veterans Affairs Long Term Care Planning Model and the National Long Term Care Survey. University of Pennsylvania. 2009. Web. 22 March Lapham, S.C., Hall, M., Skipper, B.J. ‘Homelessness and substance abuse among alcohol abusers following participation in Project HART’. Journal of Addictive Disease14 (1995): 41-55. Print. Long term care. ‘Veterans Long Term Care Benefits’. 2007. Web. 22 March 2012 Military Handbooks. ‘2008 Veterans Healthcare Benefits.’ 2008. Web. 22 March 2012 Panangala, S. ‘Veterans’ Health Care Issues in the 109th Congress’. CRS Report for Congress. 2006. Web. 22 March 2012 Veterans Affairs. ‘Government Response to the Report of the Standing Committee on National Defence and Veterans Affairs.’ 2011. Web. 22 March 2012 Read More