Michael and his caregiver Bev Strong.
The Department of Veterans Affairs (VA) is helping Veterans find a home, and a second family in the process, by giving Veterans to chance to receive long-term health care in the private homes of caregivers.
Originally implemented by two VA social workers in Little Rock, Ark., the Medical Foster Home (MFH) program provides a lifestyle alternative to nursing homes for a segment of the Veteran population that may be looking for more independence or more personalized care.
“Medical Foster Homes are actually a type of Community Residential Care home, they’re just designed to be smaller, family environment where the Veteran can receive support and care for chronic medical conditions,” said Caitlin Oliveira, MFH Coordinator at the Boston VA Medical Center. “Veterans, who would otherwise have to move into a nursing home, can choose to stay in the community where they can be a part of a family environment and have privacy.”
A small, but significant portion of the MFH population includes younger Veterans in need of complex medical care. Most applicants are those Veterans ‘aging out’ of Community Residential Care homes and VA’s Home Based Primary Care program where patients’ needs range from behavioral and mental health conditions to complex medical and disabling conditions.
Director of Home and Community-Based Care, Dr. Thomas Edes, explains that when faced with this difficult situation, many Veterans are willing to accept medical risks in order to stay in the living situation they prefer.
“Do you allow them to stay in an unsafe situation without adequate support, even if they choose to be there?” he asked. “It’s a really difficult situation.”
The solution was to find people who were willing to take a Veteran into their private home and provide 24 hour supervision and personal assistance, while VA would provide comprehensive medical care in the homes by the Home Based Primary Care interdisciplinary teams.
Michael’s Story — A Good Match
Michael is a man of few words.
When asked about his living situation, he summed it up: “It works good, it reminds me of home.”
Michael’s home is a four-bedroom house in the suburbs of Minneapolis that belongs to Bev Strong, his caregiver and landlady. She had provided a temporary home to Michael once before as a county-certified caregiver and jumped at the opportunity to sign him up for the VA-organized program.
“I started with one Veteran and I decided that I was only going to work with the Veterans,” Strong said. Compared with her previous caregiver experience, she said that working with VA is “more rewarding, because you’ve got a lot of support.”
Her home was the first approved to join the Minneapolis Medical Foster Home program in March of 2009. Since then, she has worked closely with the Minneapolis VA MFH coordinator, Kathryn West.
“That’s been a huge opportunity; local, county, state and federal entities all learning to come together to create care that is accessible, easy to maneuver and efficient,” West said. In the two years since the national initiative began, MFH has expanded from three to 36 states. Like every program coordinator for the rapidly-growing care option, West has had to tailor the application process to meet state health care laws.
It takes a diverse inspection team to approve an applicant and their home. VA evaluations are conducted by a VA fire and safety inspector, nurse, social worker, dietician, and, often times, a rehabilitation therapist.
“Safety is paramount,” said Dr. Edes. “We have a very strong system of caregiver selection and oversight. And a very high rate of satisfaction among the Veterans in the Medical Foster Homes.”
Veterans make the final decision in selecting a MFH. Given profiles of their foster home options, they weigh questions like caregiver experience, who does the cooking and where the home is located.
“The match is the important piece,” Oliveira agreed. “Homes that have a similar personality and likes as the Veteran, they’re just going to get along well.”
In the Strong home, everyone looks forward to recreational therapy days because Bev gets a kick out of joining in during Michael’s Wii therapy. If Michael has had a successful hunting trip, Strong relies on him to prepare the venison for dinner. In the few years he has lived with Strong, a close bond has formed.
Michael sums it up: “The meals are good, the company’s great.”
Caregiver Mounier Marzouk and Fred.
Fred’s Story — “Where Heroes Meet Angels”
Mounier and Sohir Marzouk immigrated to the United States from Egypt eight years ago. Mounier had worked as a physical therapist and Sohir was a caregiver for her elderly parents. Opening their home to care for Veterans was the perfect match.
“We have no kids, we’re just me and my husband,” Sohir said. “Now we feel like we have a family.”
Fred is one of their new family members. The 86-year-old Veteran was living alone until an injury led him to move into a VA Community Living Center and then he joined the Medical Foster Home program. Now, an interdisciplinary home care team visits the Marzouk house twice a week to care for Fred and support his caregivers. MFH Program Coordinator Kathryn West credits Mounier for Fred’s greatest quality of life improvements.
“He’s a very frail older man, but Mounier got him out walking thanks to his physical therapy background in Egypt,” she said.
Mounier said he keeps Fred busy all the time with outings to the library and mall, walks and card games. Overnight, Mounier continues to keep a close watch over Fred, even spending some nights on a couch outside Fred’s room in case he needs assistance in the middle of the night.
The perfect balance of support and independence provided by medical foster homes is possible, in large part, thanks to the caregivers who open their homes and families to these Veterans.
“They all have a keen desire to help someone else,” said Dr. Edes. “It’s part of who they are and their fulfillment in life.”
Most have a background in nursing or care giving; some have a personal connection with Veterans. As with any living situation though, there are always adjustments to be made. The VA team is closely involved in the transition process and checks on both the Veteran and the caregiver multiple times each week.
West said building relationships is a significant part of her job.
“I tell them: ‘Nothing’s perfect, you’ll have times when things will frustrate you,’” she explained. “We develop trust so when those times come along, we can just talk to each other and develop positive solutions.”
VA expects a long-term commitment from these caregivers and VA supports them throughout their participation in MFH. In Minneapolis, the Marzouks got assistance with home improvement projects to make their house more maneuverable for their two Veteran residents. The VA home care team was there for them on a personal level as well.
“They always worry about me and my husband,” Sohir said. “They always give me and my husband time together. They’re worried about my life, because if you work all the time, it makes life hard.”
All Veterans in Medical Foster Homes are supported by the Program Coordinator and a full Home-Based Primary Care team or Spinal Cord Injury Home Care team, as well as supportive programming like Adult Day Health Care, Home Health Aide & Respite and Rehabilitation Therapy. So while Veterans are visited and monitored by “a consortium of clinicians,” the caregivers are aided in their 24-hour care supervision. Sohir and her husband are happy to make the commitment.
“I love him; he is like my dad,” Mounier said. Recalling a conversation he had with Fred, he added: “I told him, ‘We are here to help you anytime, anywhere.’ I will keep him until the last moment.”
Dan and his caregiver Barb Miller.
Dan’s Story — A Second Family
Dan’s home for the past nine years has been with Barb Miller.
“I really have a soft spot for Veterans; just because of what they give of themselves,” said Miller, a medical foster home provider. “I feel like I can give my residents something here that they may not have had before.”
In Dan’s case, he has found a new family and a drug-free life. The decision to move in was a difficult one, because it meant leaving behind his own house, furniture and neighborhood friends.
“I gave up a lot of stuff, but I’m glad I did it now,” he said. “My family’s here.”
The family home environment is a key attraction of the MFH care option for Veterans or for family members selecting a long-term care alternative for their loved ones. It has been a popular choice with Veterans, even though they are responsible for paying the MFH caregiver.
A contract is made between the caregiver and the Veteran, who pays for their monthly rent, board and assistance with personal care. This cost is frequently offset by the Veteran’s other VA financial benefits and any other income they may have.
“Twenty-seven percent of our Veterans are highly service-connected and ostensibly would be able to have VA pay for their care in a VA long-term care facility,” said Dan Goedken, Medical Foster Home National Program Coordinator. “Instead they choose to use their financial resources and pay for their care at a medical foster home. That’s a pretty significant percentage, and underscores the Veteran’s choice for MFH.”
Receiving in-home care has also improved the health of those Veterans in the MFH program. The number of days they spend in the hospital is cut in half and the number of nursing home days is reduced by 70 to 80 percent. In all, total VA health care costs are reduced by 24 percent.
“Veterans have the choice of not needing to go into a long-term care setting and the VA is still very much involved in the care,” said Goedken. “It is a personalized setting, it’s a home environment and yet they receive a lot of clinical support from the VA to help maintain the Veteran.”
As a caregiver, Miller enjoys the supportive home care team which is available to check the status of prescription orders and conduct check-ups at the house while the Veterans enjoy individualized attention. She has found that the right amount of independence and attention can help a Veteran to flourish.
“A lot of Veterans feel like they’ve been institutionalized, but here they feel like they’re in a home and that’s extremely important to them,” Miller explained. “I think we’re really a total family unit. I tell clients: ‘Even though you have a family, you have a second family here.’”