New York & Veterans Directed New York & Veterans Directed Home and Community Based Home and Community Based

Services ProgramServices ProgramPhilip McCallion & Lisa A. Philip McCallion & Lisa A. Ferretti, Center for Ferretti, Center for Excellence in Aging Excellence in Aging Services Services www.albany.edu/aging Gail Koser & Rina Gail Koser & Rina Kitazawa Kitazawa NY State Office for Aging NY State Office for Aging

Background Background

VDHCBS introduced as a new component VDHCBS introduced as a new component of AoA’s 2008 Nursing Home Diversion of AoA’s 2008 Nursing Home Diversion Modernization Grant Modernization Grant

NYSOFA worked with VA and AAAs to NYSOFA worked with VA and AAAs to submit an application for VDHCBS submit an application for VDHCBS

New York State – one of 10 states to be New York State – one of 10 states to be awarded the VDHCBS grant in September awarded the VDHCBS grant in September 0808

New York also selected in 2009 for New York also selected in 2009 for Community Living Program & VDHCBSCommunity Living Program & VDHCBS

Program Goals Program Goals

To better serve veterans of all ages at To better serve veterans of all ages at risk of nursing home placement risk of nursing home placement

To encourage collaboration and To encourage collaboration and partnerships between Aging and VA partnerships between Aging and VA networks networks

To reduce duplication of effort and To reduce duplication of effort and resourcesresources

To replicate and expand program in To replicate and expand program in other areas of the State other areas of the State

Elements of VDHCBS Elements of VDHCBS

Veterans Health Administration will Veterans Health Administration will purchase consumer directed and other purchase consumer directed and other home and community based services home and community based services from the Aging Network for eligible from the Aging Network for eligible veterans of all ages.veterans of all ages.

Consumer directed personal care Consumer directed personal care services a necessary componentservices a necessary component

Provider agreement between the local Provider agreement between the local VA Medical Center and counties/AAAs VA Medical Center and counties/AAAs

Necessary Steps for Necessary Steps for VDHCBSVDHCBS

Development of consumer directed Development of consumer directed infrastructureinfrastructure

Completion & Review of Readiness Completion & Review of Readiness Tool Tool

Determination of services and rates Determination of services and rates

Review and signing of the Provider Review and signing of the Provider AgreementAgreement

VISN 2 Counties Selected for VISN 2 Counties Selected for Veteran Directed Model Veteran Directed Model

10/1/08 – 3/31/09 (FY-09)10/1/08 – 3/31/09 (FY-09)

OnondagaOnondaga– Currently enrolled in Primary CareCurrently enrolled in Primary Care 63706370

Over 80 years oldOver 80 years old 13401340

BroomeBroome– Currently Enrolled in Primary CareCurrently Enrolled in Primary Care 26782678

Over 80 years oldOver 80 years old 572 572

OneidaOneida– Currently Enrolled in Primary CareCurrently Enrolled in Primary Care 36233623

Over 80 years oldOver 80 years old 659 659

VDHCBS Process VDHCBS Process

VA MC identifies eligible veterans and refers VA MC identifies eligible veterans and refers them to the AAA.them to the AAA.

AAA contacts the veteran and completes an AAA contacts the veteran and completes an intake assessment.intake assessment.

AAA develops a care plan and budget. AAA develops a care plan and budget.

VA MC authorizes the care plan and budget. VA MC authorizes the care plan and budget.

AAA submits invoices to VA MC each month. AAA submits invoices to VA MC each month.

VA MC provides payment to the AAA. VA MC provides payment to the AAA.

Challenges of VDHCBS Challenges of VDHCBS

VDHCBS is an evolving program.VDHCBS is an evolving program.

Consumer directed careConsumer directed care needs to be in needs to be in place before proceeding with VDHCBS. place before proceeding with VDHCBS.

Aging and VA networks must learn about Aging and VA networks must learn about each other’s systems, processes, and each other’s systems, processes, and requirements.requirements.

Aging network must learn to work with a Aging network must learn to work with a new population with needs that may differ new population with needs that may differ from older adult clients (e.g. veterans with from older adult clients (e.g. veterans with TBI). TBI).

Specific ChallengesSpecific Challenges

Using existing case managers versus Using existing case managers versus designated care coordinatorsdesignated care coordinators

Costing servicesCosting services

HIPPAHIPPA

Start-up costsStart-up costs

The ProcessThe Process

Referral to VDHCBSReferral to VDHCBS: :

The VA Medical Center determines a veteran’s eligibility for The VA Medical Center determines a veteran’s eligibility for VDHCBS and refers eligible veterans to the Area Agency on Aging.VDHCBS and refers eligible veterans to the Area Agency on Aging.

Care plan:Care plan: Veterans who choose VDHCBS work with a Care Coordinator or Veterans who choose VDHCBS work with a Care Coordinator or Case Manager at the Area Agency on Aging and any others whom Case Manager at the Area Agency on Aging and any others whom the veteran chooses. These individuals help the veteran design a the veteran chooses. These individuals help the veteran design a care plan that includes all the care and services needed. This group care plan that includes all the care and services needed. This group of people is called a care team.of people is called a care team.

Budget:Budget: Veterans have staff from an agency, called a fiscal intermediary, to Veterans have staff from an agency, called a fiscal intermediary, to help them manage a monthly budget. The amount of money in the help them manage a monthly budget. The amount of money in the monthly budget is based on the participant’s care plan. monthly budget is based on the participant’s care plan.

ServicesServices

Personal carePersonal care

HousekeepingHousekeeping

Chore and companion/supervision servicesChore and companion/supervision services

Social or medical adult day careSocial or medical adult day care

Home delivered mealsHome delivered meals

Congregate mealsCongregate meals

Nutrition educationNutrition education

Nutrition counselingNutrition counseling

Caregiver support including training, counseling, support Caregiver support including training, counseling, support groups and respitegroups and respite

Health promotionHealth promotion

TransportationTransportation

GoodsGoods

Appliances Appliances

Assistive devices/assistive technologyAssistive devices/assistive technology

Some at least will be funded through Some at least will be funded through existing VHA programsexisting VHA programs

Opportunities Opportunities

Increased communication between Increased communication between the Aging and VA networks at local, the Aging and VA networks at local, State, federal levelState, federal level

New and ongoing source of funding New and ongoing source of funding for AAAsfor AAAs

Discussion of other partnership Discussion of other partnership opportunities between Aging and VAopportunities between Aging and VA

Collaboration with other states Collaboration with other states