va geriatrics and extended care continuum – empowering veterans to rise above the challenges of...

VA Geriatrics and Extended Care Continuum – Empowering Veterans to Rise Above the Challenges of Aging, Disability, or Serious Illness

1March 3, 2015

Richard M. Allman, MDChief Consultant, Geriatrics and Extended CareDepartment of Veterans Aff airsWashington, DC

National Association of State Veterans Homes Winter Conference

VETERANS HEALTH ADMINISTRATION

Presentation Goals • Describe organizational structure, vision, mission,

and goals for VHA Geriatrics and Extended Care (GEC) programs

• Provide an overview of the comprehensive nature of GEC programs and the opportunities they provide to address VHA challenges

• Promote discussion of the value of the partnership between the NASVH and VHA


VA Mission

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Mission:

Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile & Integrated

Core Values: Integrity, Commitment, Advocacy, Respect & Excellence


Veterans Health Administration (VHA) Health

System

• 135 Community Living Centers

• 300 Vet Centers

• 150 Medical Centers• 985 Outpatient Clinics

820 Community-Based 150 Hospital-Based 9 Mobile

6 Independent

• 104 Domiciliary Residential Rehabilitation Programs

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• 70 Mobile Vet Centers

Source: FY 2014 1st Quarter Pocket Card

• 21 Veterans Integrated Service Networks (VISNs)

Serving 8.9 million enrolled Veterans, half of whom are age 65 years or greater


* Source: American Customer Satisfaction Index

Patient Satisfaction ScoresVA has topped private sector hospitals in patient

satisfaction for a full decade.

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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

VHA Inpatients

82 81 81 84 83 84 83 85 84 85 85 84

VHA Outpatients

79 79 80 83 80 82 83 81 83 82 83 82

Private-Sector Hospitals

68 70 73 76 71 74 77 75 77 73 76 76


VA is the largest provider of health care training in the United States and maintains more than 5,000 individual affiliation agreements at more than 1,800 educational institutions.

In FY 2013, VA provided clinical traineeships and fellowships to more than 117,000 students in more than 40 professions.

Preparing the Nation’s Health Professionals for Tomorrow

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Geriatrics and Extended Care – Providing Solutions for Veterans Facing Challenges

Geriatrics and Extended Care (GEC) Mission:Empowering Veterans and the Nation to rise above the challenges

of aging, disability, or serious illness

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GEC Mission

GEC Programs

Triple AIM for VHA

Improving Performance

Promoting a positive culture of service

Advancing healthcare innovation for Veterans and the country

Increasing operational effectiveness and accountability

Blueprint for Excellence Themes


Veterans Health Administration (VHA) Organizational Chart

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Updated October 2013

Under Secretary for Health

Principal Deputy Under Secretary for Health

Finance Nursing

ADUSH for Quality, Safety

& Value

ADUSH for Workforce

Services

Strategic Integration

Health Equity

Research Oversight

Medical Inspector

Readjustment Counseling

Deputy Under Secretary for Health for Policy & Services

ADUSH for Policy & Planning

ADUSH for Patient Care

Services

ADUSH for Informatics & Analytics

Public Health

Interagency Health Affairs

Ethics in Healthcare

Research & Development

Chief of Staff

Deputy Chief of Staff

ADUSH for Clinical

Operations

ADUSH for Administrative

Operations

21 VISNs

Patient Centered

Care

Deputy Under Secretary for Health for Operations & Management

Geriatrics and Extended Care

Operations

Geriatrics and Extended Care

Policy and Service


Geriatrics and Extended Care (GEC) Vision

Chief Consultant, Policy and ServicesRichard M. Allman, MD

Executive Director, OperationsThomas Edes, MD

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Common Vision: One GEC – Empowering Veterans and the Nation to rise above the challenges of aging, disability, or serious illness


GEC MISSION

Honor Veteran’s preferences for health, independence, and well-being in the face of

aging, disability, or illness by advancing expertise, programs, and partnerships.


Geriatrics and Extended Care Programs (GEC) for All Veterans

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Independence DependenceEnd of Life

Ambulatory Care

Inpatient Acute

Facility Based LTSS1

Home & Community Based LTSS1

Hospice Care2

Geriatric Evaluation &

Management, Geriatric

Primary Care (Geri-PACT), Outpatient

Palliative Care

Adult Day Health Care, Home Based Primary Care,

Homemaker & Home Health Aide, Community

Residential & Medical Foster Care, Respite,

Skilled Home and Palliative Care, Veteran Directed

Care

Geriatric Evaluation and Palliative Care Units, Geriatric and Palliative Care Consults

VA Community Living Centers,

Community Nursing Homes,

State Veterans Homes

Portfolio of Geriatrics and Extended Care (GEC) Programs

Continuum of Vulnerability

Geriatric Research, Education, and Clinical Centers (GRECCs), Geriatrics and Extended Care Field Programs & Data Analysis Center

Innovations in Veteran Care and Healthcare Workforce Development1LTSS = Long term services and supports; 2 www.WeHonorVeterans.org

Community Home Hospice

and VA Inpatient Hospice


Geriatric Research, Education, and Clinical Center (GRECC) Locations

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Eastern Colorado GRECC


167 Innovative, Non-Institutional Long Term Care Models Implemented FY 2010-14

• Advanced Care Planning• Shared Decision Making• Care Management• Delirium Care• Dementia Programs• Geriatric Consultation• Geriatric Patient Aligned Care Teams

(GERI-PACT)• Hospital at Home*• Home Based Primary Care

• Hospice and Palliative Care• Medication Reconciliation• Rehabilitation• Mobile Care Units• Programs of All Inclusive Care for the

Elderly (PACE)• Staff Geriatric Education• Transitional Care

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Innovations and Improvements in Care in Geriatrics and Extended

Care

*Recognized by Joint Commission as a Best Practice


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Using appropriate risk stratification and population health strategies, GEC programs improve health, safety, independence and purpose: – Reduce mortality– Reduce hospital readmissions– Reduce total health care costs– Shorten length of hospital stays– Minimize adverse drug reactions– Enhance patient and family satisfaction – Improve patient function and independence– Delay or reduce need for nursing home stays– Lower risk of hospital acquired complications such as delirium

Geriatrics and Extended Care Program Outcomes


Numbers of Veterans Using GEC Services

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2006 2007 2008 2009 2010 2011 2012 2013 250,000

270,000

290,000

310,000

330,000

350,000

370,000

390,000

Total Unique Veterans

Source – GEC DAC


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Growth in GEC Programs

*Home and community based services

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

10000

20000

30000

40000

50000

60000

70000

NH Average Daily Census HCBS Average Daily Census LTC total recipients

Source: H. Stephen Kaye, Center for Personal Assistance Services, University of California San Francisco. PAS Center funded by National Institute on Dis-ability & Rehabilitation Research


Numbers of Veterans Receiving Home Based Primary Care

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2006 2007 2008 2009 2010 2011 2012 20130

10000

20000

30000

40000

50000

60000

2115922587

28663

34362

38624

4311746246

49112

HBPC Uniques

Source: GEC DAC


Number of Veteran Enrollees by Age

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Projected Enrollees Over 65 Years OldP1a Doubles in Next Decade


Percentage of P1As for Whom VA Must Provide Nursing Home Care


• Medical Foster Homes 1 – “I would say that if you want to have some comradeship, some

fun and enjoyment and get along with the other guys and people, do it. Do it. It gives you more security, more feeling of belonging. It’s good.“ – Veteran

– “Freedom. I have freedom. I just appreciate all the VA has done to make living here more comfortable and safe, definitely safe.” - Veteran

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GEC And Veteran Experience

1 http://youtu.be/73ypDaRgomA


• Hospice/Palliative Care1

– “All the love I’ve ever needed in my life is here. I have a leukemia that right now I’m living on blood transfusions and I could get to a point where I really don’t care about much of anything. And the people here provide me with the love to never have to go in that direction. It keeps me alive that love.” - Veteran

– “I have been emotionally drained, really emotionally drained, and they lift me. They really do. We didn’t even know that this was available and I need to say how wonderful it’s been. I can’t say enough for the care. I thought it would be kind of sad but it’s happy, clean. I love it.” - Caregiver

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1 http://youtu.be/UNGiZGn2miQ


• Home Based Primary Care– “They kept me out. Yeah, I haven’t even had to go to the

emergency room, not one time that I remember. As far as I remember, I wasn’t in there at all. So I’m just thrilled, you know. When you go from five [ER visits] to none, somebody is doing their job.”

– There would have been a lot of times, like now, that I couldn’t hardly make it…. But now in this program, I believe that I can keep him right here in the house.” (Caregiver of WWII Veteran)

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• Veterans Directed Home & Community Base Services Program: 2014 Veteran Experience Analysis1

– Veterans report a high level of satisfaction regarding choice and control

– Veterans strongly agree or agree (99%) that caregivers do things the way they want them done (79 respondents)

– Veterans strongly agree or agree (91%) that they control how they spend their VD-HCBS budget (53 respondent)

– Veterans reported that the VD-HCBS is highly successful in maintaining independence while improving the quality of the Veteran’s life

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1 The Veterans Directed Home & Community Based Services Program: Veteran Experience Analysis. Conducted by The Lewin Group


GEC Progress in SystematicallyCapturing Veteran Experience

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• Experience with Palliative Care: The Bereaved Family Survey– Families rate aspects of care in the last month of life; communication,

emotional and spiritual support, pain & PTSD management, personal care needs, Veteran benefits

FY09 n=5,016

FY10 n=11,194

FY11 n=11,773

FY12 n=11,019

FY13 n=8,810

FY15 goal20%

30%

40%

50%

60%

70%56% 57% 58% 59%

63% 65%

% of Families Rating End of Life Care as “Excellent”


Small Home Model Supports State-of-the-Art Care

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Goals to Guide The Way Forward

• Provide leadership and oversight for a well-integrated, system-wide continuum of evidence-based, Veteran-centric GEC programs and services to meet the needs of Veterans, families, and their caregivers.

• Establish infrastructure, promote innovation and the use of data, tools, and continuous quality improvement approaches to ensure personalized, proactive, Veteran-centered care.

• Ensure Veterans have reliable access to quality care in facility, community, and home-based settings, delivered by appropriately trained health care professionals, teams, and caregivers.


Goals to Guide The Way Forward

• Achieve exceptional outcomes including exemplary Veteran, employee, and other stakeholder satisfaction with our programs and services.

• Be excellent financial stewards in delivering high-value programs and services through accountability, collaboration, engagement, and alignment of GEC resources with VACO, VISN, medical centers, clinics, and external partners.

VA Geriatrics and Extended Care Continuum – Empowering Veterans to Rise Above the Challenges of Aging, Disability, or Serious Illness

30March 3, 2015

Richard M. Allman, MDChief Consultant, Geriatrics and Extended CareDepartment of Veterans Aff airsWashington, DC

National Association of State Veterans Homes Winter Conference

va geriatrics and extended care continuum – empowering veterans to rise above the challenges of...

Documents

enrolled veterans

vha geriatrics

nations health professionals

health principal deputy

vha overview version

extended care gec mission

medical centers

community living centers