AGING & INDEPENDENCE SERVICES
San Diego’s
Veterans Services at any Age
What is the
Veteran’s Directed Home
and Community Based
Services?
SAN DIEGO’S VD-HCBS
PROGRAM DEVELOPMENT
1 YEAR IN THE MAKING!
Technical Consultants:
• Molly Murphy, Merle Edwards Orr, Roger Auerbach, Patrick Brady
Readiness Review
• Program
o P & P
o Veteran Handbook
• Financial
Mock Referral
Program Agreement
SD-VISA
VET
VA
AISPremier
WHAT IS SELF-DIRECTION?
Veteran
Agency recruits
and manages workers
Program and
agency set tasks
Agency specifies
salary and benefits
Normal work hour schedule
Agency requires worker training
Case manager
determines needs and
services
Traditional Services
Veteran
Recruits, hires, and manages workers
Sets tasks
Specifies salary and benefits
(optional)
Assigns flexible work
hour schedule
Trains/ arranges worker training
Makes decisions
about needs and services
Self-Directed Services
6
VAMC
Sends all referrals with:
Geriatric Extended Care Assessment
Completed Case Mix
Proposed Budget
Veteran has already been informed of program
AIS’ ROLES
1. Act as intermediary between
Veteran, FMS and VA liaison
2. Provide fiscal oversight
3. Ensure program integrity
AIS’ ROLES
4. Options Counseling
• Veteran and family centered
• Interactive & decision-supportive process
• Assist Veterans to identify & understand their needs
• Establish Action Plans
VISA SPENDING PLAN
FMS- PREMIER HEALTHCARE SERVICES
AGENCY WITH CHOICE VS FE/A
F/EA WAS INITIALLY APPROVED…
What is a F/EA or Fiscal Employer Agent?
Fiscal/Employer Agent (F/EA) providers
perform various administrative and payroll
tasks to help program participants be the
Employer of Record (EOR). In this program
model, participants are the sole employers
responsible for hiring, training, scheduling
and terminating their own caregivers. This
model gives the participant the most control.
WORKER’S COMPENSATION
POLICY PURCHASE PRICE WAS PROHIBITIVE
Under F/EA model each participant had to purchase
Workers Compensation
• Most carriers wouldn’t even quote a price
• State Fund is the mandated provider and the cost
was approximately $2500
Under Agency with Choice model participants are
covered under the FMS global policy
ACL and the central VA were hesitant to approve the
AWC model
• Problems with FMS agencies “double dipping”
• Does participant maintain Employer Authority
AGENCY WITH CHOICE VS F/EA CONT..
AGENCY WITH CHOICE WAS THE PREVAILING MODEL
Agency with Choice-
“The agency and participants are co-employers of the workers
whom participants recruit and refer to the agency…” - NRCPDS
Participant maintains Employer Authority and Budget Authority
while the Agency handles the administrative burden of employing
a provider. This allows the Participant to focus on managing their
long term services and supports (LTSS).
AGENCY WITH CHOICE BENEFITS
AWC ROLES AND RESPONSIBILITIES
Agency considered the “Primary” employer
Pays Workers & Service Providers
Less Risk for Participant of claims or lawsuits
• Labor claims
• OT claims
• Workers Comp Insurance & Claims
Participant Maintains “Budget and Employer” Authority
• Considered the “Managing” Employer
Co-Employment Recognized by DOL not IRS
• Agency liable for proper employer / employee taxation
• Participant may share some liability for labor claims
WHO ARE WE SERVING?
Korean War
World War II
WHO ARE WE SERVING?
FUNCTIONAL ABILITY
ON AVERAGE
Have 6 ADL Dependencies
Have an average budget of $3111/Mo
50% of Veterans referred meet criteria for “High Needs”
50% of Veterans referred have Dementia
• Other Medical Issues include: Depression, PTSD, CHF
SURVEY OUTCOMES
Overall 90% were satisfied with all aspects
of the SD-VISA Program.
100% of Veterans interviewed indicated that
this program has allowed them to remain
safely in their home.
100% of Veterans indicated that they were
satisfied with the quality of their care.
100% reported improvement in their quality
of life.
COMPARISON: VASDHS vs. SD-VISA
HOURS OF CARE COST PER YEAR
$812,832
5M
2M
1M
800K
600K
SD VISA
VASDHS
$1,143,828
53,736
10,444
Yearly
60K
50K
40K
30K
20K
10K
SD VISA
VASDHS
51% Decrease in
Readmissions
20% Avoided SNF
Placement$1.6 M
KEYS TO SUCCESS
Committed to helping our San Diego Veterans
• Right staff
All at the table
• From beginning and continues
Communication
• Do not underestimate
the importance
Flexibility
Transparency
CHALLENGES
Sustainability
Helping Veterans think outside the box
A VETERAN’S STORY
Michael and Betsy Winniman
San Marcos, CA
“Because of the
SD-VISA Program,
I know that the VA is
100% behind me.”
~Veteran, Michael Adams
QUESTIONS?