The feds' fading commitment to veterans.The number of military veterans most in need of long-term care--those 85 years and older--is growing dramatically. Typical World War II servicemen who were 20 years old in 1942 will reach their 83rd birthday this year; they will be quickly followed by Korean War veterans ≈The last U.S. Korean War veteran on active duty was Lt.Col Don Byers, US Army, who retired in 1992
Despite the dictates of demography demography (dĭmŏg`rəfē), science of human population. Demography represents a fundamental approach to the understanding of human society. , the use of institutional long-term care long-term care (LTC), n the provision of medical, social, and personal care services on a recurring or continuing basis to persons with chronic physical or mental disorders. provided by the Department of Veterans Affairs Veterans Affairs is a term of the business that deals with the relation between a government and its veteran communities, usually administered by the designated government agency. (VA) is growing far more slowly. The number of veterans receiving nursing home care delivered in VA facilities, state-operated veterans homes, and contracted SNFs rose only from 30,740 in FY 2000 to 33,000 in FY 2003. More surprisingly, current VA plans assume that the number of veterans receiving long-term skilled nursing care will actually decline by 5% in FY 2005. Many advocates for veteran's healthcare wonder how the VA plans to accomplish this magic while retaining its dedication to need-based care for America's veterans. Everett Alvarez, Jr., former deputy administrator of the VA, recently identified several reasons he believes that long-term care of veterans should remain a high priority for direct services by the VA. First, veterans are very different from typical nursing home residents because they are primarily men and have different psychological and supportive needs. Second, their primary care resources also are different from those of other nursing home residents; at a minimum, their post-acute care needs generally are coordinated with a VA hospital rather than with the community's health system. Third, the relative stability of the VA workforce in comparison with the high turnover among nursing staff in civilian healthcare provides important benefits to veterans who have been receiving care for combat-related disabilities incurred decades earlier. [ILLUSTRATION OMITTED] The Veterans Millennium Health Care and Benefits Act, signed into law by President Clinton in November 1999, plays up these advantages. It requires the VA to adopt the goal of providing as much long-term care as it did in 1998. As shown in the accompanying table, this care can take several forms: nursing home care, "domiciliary domiciliary pertaining to a household. domiciliary calls professional veterinary calls made to patients at their owners' residences. Called also house calls. " care (i.e., equivalent to a board-and-care facility rather than a SNF SNF abbr. skilled nursing facility SNF solids-not-fat; a comment on the composition of milk. ), home-based primary care, and adult day care. Nursing home care can be provided in VA facilities, in community-based SNFs on a per diem per diem adj. or n. Latin for "per day," it is short for payment of daily expenses and/or fees of an employee or an agent. contract, or in state-operated veterans homes. In 2003, the U.S. General Accounting Office (now known as the Government Accountability Office The Government Accountability Office (GAO) is the audit, evaluation, and investigative arm of the United States Congress, and thus an agency in the Legislative Branch of the United States Government. ) reported to Congress that the long-term care provisions of the Veterans Millennium Health Care and Benefits Act had not been met. Specifically, the VA had consistently failed to provide long-term care services at the level achieved in 1998. In some years, care delivered fell nearly 10% below the 1998 level, as measured in workload hours. Since that report was forwarded to Congress, the VA has increased the number of full-time employees in its nursing home care units and outpatient outpatient /out·pa·tient/ (-pa-shent) a patient who comes to the hospital, clinic, or dispensary for diagnosis and/or treatment but does not occupy a bed. out·pa·tient n. programs, but now plans to make staff reductions again. One reason for the planned staff reduction and the declining census in VA long-term care units has been a shift toward giving states responsibility for the care of elderly veterans. Some of this shift takes the form of increased nursing home census in state-operated veterans homes, where the VA pays one-third of the daily cost of care. Under the Bush administration, the number of veterans receiving nursing care in state-operated homes has risen from a daily average census of 15,243 to roughly 18,000, with further growth planned for this year. State governments are also being tapped for Medicaid funds Noun 1. Medicaid funds - public funds used to pay for Medicaid cash in hand, finances, funds, monetary resource, pecuniary resource - assets in the form of money to support "their" veterans; this particularly affects contracted care in community-based nursing homes. The VA is shifting increasingly from long-term contracts with private-sector nursing homes to shorter-term contracts, with the expectation that Medicaid or private long-term care insurance will pick up the tab for the patient after the VA contract period ends. In line with a general trend in long-term care, however, the biggest change in expectation during the past few years has been that more veterans will receive care in their own homes or the homes of family members. The 2005 budget for VA long-term care anticipates a 30% increase in the number of veterans receiving services as outpatients. This anticipates that family members will step forward to provide the bulk of care to the growing population of World War II and Korean War veterans with disabling dis·a·ble tr.v. dis·a·bled, dis·a·bling, dis·a·bles 1. To deprive of capability or effectiveness, especially to impair the physical abilities of. 2. Law To render legally disqualified. chronic healthcare conditions. VA spokespersons point to advances in telemedicine ("long distance" medicine) Using a videoconferencing link to a large medical center in order that rural health care facilities can perform diagnosis and treatment. A specialist can monitor the patient remotely taking cues from the general practitioner or nurse who is actually examining and other technology as tools that will justify the movement of large amounts of long-term care from VA facilities to private homes. The problem with this wishful thinking wishful thinking Psychology Dereitic thought that a thing or event should have a specified outcome is that it is based more on the state of federal finances than on any serious analysis of the abilities of home-based care providers, state government payers, and private insurance. The changes proposed in the VA's long-term care service mix are far more dramatic than the changes observed in either technology or payment systems. Relying on spouses and family members to shoulder an increasing share of our country's responsibility for the long-term care of those who have fought for freedom from fascism fascism (făsh`ĭzəm), totalitarian philosophy of government that glorifies the state and nation and assigns to the state control over every aspect of national life. and communism communism, fundamentally, a system of social organization in which property (especially real property and the means of production) is held in common. Thus, the ejido system of the indigenous people of Mexico and the property-and-work system of the Inca were both may sound like an attractive solution from the taxpayer standpoint The Standpoint is a newspaper published in the British Virgin Islands. It was originally published under the name Pennysaver, largely as a shopping-coupon promotional newspaper, but since emerged as one of the most influential sources of journalism in the , but it really means that thousands of elderly children and spouses will be expected to devote much of their retirements to the care of increasingly disabled veterans. To send your comments to the author and editors, e-mail stoil0805@nursinghomesmagazine.com.
Table. VA long-term care (average daily census by fiscal year)
2000 2001 2002 2003 2004 2005
(est.) (projected)
VA nursing 11,812 11,672 11,969 12,339 11,000 8,500
State home nursing 15,243 15,471 15,833 17,000 18,000 19,010
Contracted SNF care 3,685 3,990 3,834 4,069 4,069 4,069
All nursing home 30,740 31,333 31,636 33,408 33,069 31,579
care
VA domiciliaries 5,301 5,394 5,484 5,425 5,378 5,312
State home 3,684 4,402 3,772 3,758 4,389 4,389
domiciliaries
All domiciliaries 8,985 9,796 9,256 9,183 9,767 9,701
Noninstitutional 14,111 16,150 17,465 18,321 23,514 30,372
care (e.g., adult
day, respite,
home hospice)
Total census 53,836 56,719 58,357 60,912 66,350 71,652
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