VA Testimony of Gladys Dickerson before Congress on April 25, 2002

United States Department of Veterans Affairs

STATEMENT OF
GLADYS M. DICKERSON, RN, BSN
NURSE MANAGER/COORDINATOR, HOME BASED PRIMARY CARE
VA NORTH TEXAS HEALTH CARE SYSTEMS
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
COMMITTEE ON VETERANS AFFAIRS
UNITED STATES SENATE
WITH RESPECT TO
NON-INSTITUTIONAL ALTERNATIVES TO LONG TERM CARE

April 25, 2002

Mr. Chairman and Members of the Committee:

I appreciate the opportunity to speak before you today regarding alternatives to Institutionalization in Long Term Care. Home Based Primary Care ( HBPC) and those programs associated with HBPC; ensure that the right care, at the right time, in the right setting is available to veterans all over the nation. Programs such as HBPC, Adult Day Care, Telemedicine, Advances in Home Based Primary Care for End of Life in Advancing Dementia (AHEAD), Senior Companion, In-Home Respite, and Assisted Living ensure veterans receive alternatives to institutional care. These services can be provided at a much-reduced cost to the VA system and keep the patient out of an acute care bed and at home, where they prefer to remain.

The number of veterans with long-term health care needs is increasing as the population ages. Currently, there are an estimated 600,000 individuals with dementia within the veteran population.

Dementia and similar diseases are progressive. Their victims are vulnerable to accidents and injuries that ultimately make them completely dependent in all aspects of daily living. These diseases are projected to triple in the veteran population over age 65. The incurable nature of most long-term conditions, the suffering it causes patients and their families, and the cost of care make managing diseases such as dementia and others a priority to promote non-institutional care for VA.

Home and community based care allows veterans to live at home rather than in an institution, making this a "win-win" situation for such programs as the HBPC and AHEAD Project. The family is able to participate in quality of life issues with the veteran in their home environment. The cost of care is usually lower than care provided in a skilled care facility.

Across the VHA, data indicates many families prefer to keep the veteran at home but they are unable to, as the veteran becomes more impaired. The AHEAD project through HBPC focuses on the dementia patient's problems. Focus areas are, early identification, caregiver support, completion of Advance Directives, and symptom management. The project allows veterans to receive appropriate care in a location they prefer and helps sustain caregivers in their vital role.

In the AHEAD Project, 20 VA facilities around the country completed a nine-month collaboration, committed to improving care of veterans with dementia who prefer to live at home. These teams demonstrated notable success in early identification of dementia, symptom management, caregiver support, and staff education. Home Based Primary Care is the most cost effective way to deliver interdisciplinary health care.

The HBPC Program

offers long-term patients this kind of care an alternative to nursing home placement; minimizes the amount of follow up in an Ambulatory Care Clinic; prevents premature admissions to long-term care institutions;
maintains optimal physical, cognitive, and psychosocial functioning;
and
allows the patient the option of dying at home rather than in an institution.

The purposes of the Community Adult Day Care facilities are:

to enable functionally impaired individuals to reside in a supportive home environment rather than nursing home care facilities;
to facilitate the return of older veterans to their homes and to coordinate their long-term care;
to maintain the older veteran at the highest level of functioning possible (physical, social and medical); and
to provide the family and caregivers with professional support, enabling them to maintain disabled veterans in the community.

The Senior Companion Program often makes the difference between living at home or in an institutional setting. This translates into major health care savings for seniors, their families, and taxpayers. Nursing home care costs an average of $38,000 annually per person. However, the cost of supporting one Senior Companion for an entire year is $3,850.

Telemedicine technology allows us to reduce travel time and costs, improves efficiency and provides better quality care.

In conclusion, funding and expansion of all HBPC Programs can ensure alternatives to institutionalization for the long-term veteran patient. With these expanded programs, innovative approaches to long-term care can be established with a cost saving to VHA, patients and their caregivers. HBPC keeps families together.

This concludes my remarks. I will be happy to respond to any questions you may have.