Clinical Programs In Aging
Typically, older persons have higher use of health care services, including increased number of physician visits, short-term hospital stays, number of days in the hospital, and greater need for long-term care services. Anticipating these needs, VA has developed a broad continuum of geriatrics and extended care services that are provided in a wide variety of settings, including home and the community, outpatient clinics, hospitals, and nursing homes. Together these programs provide preventive, acute, rehabilitative, and extended care on an outpatient and inpatient basis. Home- and community-based programs are emphasized, with coordinated use of hospital and nursing home programs. The shared purpose of these programs is to prevent or lessen the burden of disability on older, frail, chronically ill patients and their families, and to maximize each veteran’s functional independence.
Several innovative home- and communitybased services are offered. These include Home-Based Primary Care (HBPC), which provides in-home primary medical care to veterans with chronic illnesses. A home-based, interdisciplinary treatment team prescribes medical, nursing, social, rehabilitation, and dietetic regimens and provides training in supportive care to the patient and family caregivers. In addition, VA’s homemaker/home health aide program enables selected patients who meet criteria for nursing home placement to remain at home through the provision of personal care services purchased by VA from public and private agencies in the community, with case management provided directly by VA staff. VA also offers Adult Day Health Care, which provides health maintenance and rehabilitation services to veterans in a congregate, outpatient setting during daytime hours. This program uses a medical model of services, which in some circumstances may be a substitute for nursing home care. Another communitybased program is Community Residential Care/ Assisted Living, in which private homes provide room, board, personal care, and general healthcare supervision, at the veteran’s expense. Veterans in this program do not require hospital or nursing home care, but because of health conditions, they are not able to live independently and have no suitable support system to provide needed care. All residential care homes are regularly inspected by a multidisciplinary team of VA staff, and veterans in this program receive monthly visits from VA health care professionals who monitor the care provided in the home.
VA Domiciliaries are residential rehabilitation and health maintenance centers for veterans who do not require hospital or nursing home care but are unable to live independently because of medical or psychiatric disabilities. Veterans receive medical and psychiatric care, rehabilitative assistance, and other therapeutic interventions on an outpatient basis from the host hospital, while residing in the structured, therapeutic, homelike environment of the domiciliary. There are specialized, interdisciplinary treatment programs for rehabilitation of head trauma, stroke, mental illness, chronic alcoholism, heart disease, and a wide range of other disabling conditions. For some veterans, domiciliary care can help prepare for return to independent or semi-independent community living.
In the area of geriatric assessment, VA pioneered the concept of the Geriatric Evaluation and Management (GEM) program, which includes inpatient units, outpatient clinics, and consultation services. An interdisciplinary health care team provides comprehensive, multidimensional evaluations for a targeted group of older patients with multiple acute and chronic diseases, functional impairments, and psychosocial problems.
For veterans in need of skilled nursing care and related medical services, there are VA hospital–based nursing home care units. These units employ an interdisciplinary care approach to meet the multiple physical, social, psychological, and spiritual needs of patients. Many also provide sub-acute and post-acute care.
All VA facilities have a hospice consultation team, which coordinates a hospice and palliative care program of pain management, symptom control, and other medical services to terminally ill veterans, as well as bereavement counseling to their families. In addition, VA provides respite care to relieve spouses or other caregivers from the burden of caring for a chronically disabled veteran at home. Respite is provided for planned, brief periods of care in a variety of settings, including the veteran’s home, community nursing home, or VA hospital or nursing home.
Veterans with Alzheimer’s disease or other dementias participate in the full range of VA services, including in-home, community-based, and institutional-based acute and extended care services. In addition, some VA facilities have developed specialized inpatient or outpatient dementia services for diagnosis; management of comorbid medical, emotional, and behavioral problems; or palliative care. Programs for family caregivers of persons with dementia include support groups and caregiver education.