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Community
Based Care
Phone: 412-365-5180
Fax: 412-365-5187
Mission Statement:
The mission of the Community Based Care Service Line is to provide and
develop programs that enable veterans and their families within the Stars & Stripes Healthcare Network
to achieve and maintain the highest possible level of
health and social functioning in the community as demonstrated by:
- Internal and External Customer
Satisfaction
- Decreased veteran dependence of
Inpatient Treatment
- Improved Treatment Outcomes
- Improved Level of Functioning
Home Care Services
Home Based Primary Care (HBPC), Highland Drive
Delivers primary health care in the home through a hospital based
interdisciplinary team to the homebound, frail elderly and chronically ill
veterans whose caregivers are willing and able to assist in their care. The
interdisciplinary team, under the medical management of the physician
provides medical and psychiatric care, nursing services, psychosocial
services, rehabilitation services, and dietetic services.
Helen M. Trent, LSW, Director
Phone: 412-365-5401, Pager: 412-698-0244,
Fax: 412-365-5186.
Veronica
Conn, RN
Phone: 412-365-5402, Pager: 412-698-9246, Fax: 412-365-5186.
Homemaker/Home Health Aide (H/HHA) Program, Highland Drive
Provides homemaker and home
health aide services in the home through approved community agencies. This
service allows the veteran patient to remain in their home with familiar
surroundings and the caring support of their family. The caregiver is also
supported by allowing brief trips away from the home, therefore,
maintaining their health; which then allows continuation of care for the
veteran in their own home.
Don Maus, MSW, Coordinator
Phone: 412-365-5412, Pager: 412-306-8562, Fax: 412-365-5187
Sandal
Wright, MSW, Clinical Social Worker
Phone: 412-365-5411: Pager: 412-698-0172, Fax: 412-365-5187
Community Health Nurse Program, Heinz/Highland Drive/University Drive
Community Health Nurse Coordinators maintain a centralized referral program
which involves assessing inpatients and outpatients for home health skilled
nursing needs, exploring availability and affordability of community skilled
nursing services, completing and forwarding the Nursing Care Referral form,
and providing on-going liaison services between the home health agency and
VA healthcare providers.
Heinz:
Virginia
Legler, MSN, RN
Phone: 412-784-3380, Pager: 12-2254, Fax: 412-784-3837
Highland
Drive:
Christine
Geer, MSN, RN
Phone: 412-365-4817, Pager: 12-2287, Fax: 412-365-4608
University
Drive:
Mary Ann
McQuade-Johns, MPH, RN
Phone: 412-688-6247, Fax: 412-688-6106
Jacqueline
Blake, MSN, RN
Phone: 412-688-6870, Fax: 412-688-6106
Care
Coordination/Home Telehealth (CCHT) Program, Highland Drive
An exciting new program designed to help veterans and their providers
better manage difficult health problems. The CCHT Program involves
facility-based care coordinators, home monitoring equipment, and
telecommunications to promote the health of veterans with high-risk, chronic
diseases and help them avoid complications. Care Coordinators can help
prevent emergency room visits, hospital admissions and the need for a
nursing home placement.
Maureen Puskar, MSN, CRNP
Phone: 412-365-5196, Pager: 412-698-0064, Fax: 412-365-5186
Mary Lou Niebauer, RN, MA
Phone: 412-365-5323, Pager: 412-698-0094, Fax: 412-365-5186
Community Nursing Home Program, Highland Drive
Places patients requiring nursing home care
in community nursing homes at VA expense for qualifying veterans. Under the
Veterans Millennium health care law 106-117, community nursing home care may
be provided to veterans who are in need of such care for a service connected
disability and have a service connected disability rated at 60% or more. If
a veteran does not meet the above criteria, a social worker can determine if
funding is available for a short term contract. The residents under contract
are visited every 30 days alternately by the Nurse and Social Work
Coordinators for the program. This team also assists with discharge
planning, follow up appointments, monitoring of the quality of care
delivered to the resident in the Contract facility. In addition the CNH
under contract undergoes a yearly review to determine that it continues to
meet quality standards.
Click here
to visit the Community
Nursing Home site. This site offers additional information and
guidance regarding the Community Nursing Home program.
Holly Stapley, MN, RN
Phone: 412-365-5286, Pager: 12-4046, Fax: 412-365-5186
Harry
Weiss, LSW, MSW
Phone: 412-365-5183, Pager: 412-306-6501, Fax: 412-365-5186
Psychosocial Rehabilitation Services
Community Support Program/Mental
Health Intensive Case Management (CSP/MHICM)
Provides assertive community treatment for veterans
with major psychiatric diagnoses. Through intensive case management and
psychosocial rehabilitation, the goals of avoiding/preventing
hospitalization and increasing the quality of life in the community are
achieved.
POC: Janice Galanter, LSW, Coordinator
Phone: 412-365-4670,
Pager: 412-698-0340, Fax: 412-365-4674
Community Residential
Care Program (CRCP)
Evaluates referrals to CRCP and coordinates placements to
sponsor homes. Provides individual, and group social work services to
veterans, families, and/or residential care home staff. Monitors status of CRCP participants. Assists in selection of sponsor homes and maintains
liaison with CRCP administration and staff. Coordinates access to VA and
community resources to assure continuity of quality care to veterans.
Provides continuing education to sponsors.
Sandra Woitkowiak, LSW Coordinator
Phone:
412-365-5875, Pager: 355-1132, Fax: 412-365-5875
Psychosocial Residential Rehabilitation Program (PRRTP)
An onsite residential program that provides
opportunities for veterans to obtain the skills that translate into
successful living in the community settings of their choice. All services
are organized to accomplish this recovery goal. In addition, veterans have
opportunities for choices in the areas of socialization, vocational
rehabilitation, and education.
Tim Morrison, Coordinator
Phone: 412-365-5168, Pager: 412-698-2294, Fax: 412-365-4674
Social Work Section, University Drive
Provides team based social work services which address the
psychosocial needs of the patient and family within the acute care medical,
surgical and intensive care units. Services include patient education and
assistance in decision making; crisis intervention and grief counseling.
Coordinates timely discharge planning with the medical/surgical treatment
team, the patient and the family. Facilitates appropriate community
referrals. Social workers also provide a wide-range of clinical support
services within outpatient and short stay units (i.e. same day procedure
unit, 23 hour unit, Rainbow Team, Oncology Clinics, Hoptel, SCI, Renal,
Liver transplant, ECC, GEM).
Lovetta Ford MSW
Phone: 412-688-6203, Fax:
412-688-6919
Nekahi Walker Program Support Assistant
Phone: 412-688-6646
Comprehensive Homeless Center
Domiciliary Services
The Domiciliary Care for Homeless Veterans is a 74 bed
program to address the needs of homeless veterans. Veterans are provided
individual counseling and case management as well as groups focusing on
sobriety maintenance, problem solving, stress management, vocational
assistance and recreational activities. The goal is for veterans to return
to the community as independent productive individuals.
Gary Glacken, MSW, Coordinator
Phone: 412-365-5792, Pager:
978-0660, Fax: 412-365-5778
Health Care for Homeless Veterans Program (HCHV)
Provides outreach services to homeless veterans including
assessment, information, referral and case management. The HCHV also coordinates
a contract rehabilitation program for homeless veterans, case manages veterans
placed in the supportive housing program, assists in locating low cost housing
in the community; acts as liaison with Allegheny County homeless service
providers.
Mary Frances Pilarski, RN, MSN
Phone: 412-365-5273, Pager:
698-0124, Fax: 412-365-5795
Compensated Work Therapy (CWT)
A rehabilitation program that
creates a realistic work setting to foster the development of motivation and
work related skills. Emphasis is placed on attendance, punctuality, personal
responsibilities and acceptance of supervision to assist veterans in meeting the
demands of competitive employment. This is accomplished by procuring contracts
for various types of work of an industrial nature, with private industry. All
veterans participating in CWT receive compensation for the work performed.
John Erskine, VRS, Coordinator
Phone: 412-365-5197, Pager:
412-597-6119, Fax: 412-365-5766
Incentive Therapy (IT)
A treatment modality that uses
progressive monetary reinforcement to veterans to aid in the development of
motivation and work-related skills. Emphasis is placed on attendance,
reliability, punctuality, productivity and acceptance of supervision.
Maria Fasano, VRS
Phone: 412-365-5640, Pager: 306-9034,
Fax: 412-365-5766
Psychiatric Residential Rehabilitation Treatment Program (PRRTP)
A transitional residency program. The homes are VA-owned facilities, which
provide a therapeutic environment in which homeless veterans with a primary
diagnosis of substance abuse reside while earning income and participating in a
rehabilitation program designed to assist in the achievement of maximum level of
independence.
John Erskine, VRS, Coordinator
Phone: 412-365-5197, Pager: 412-597-6119, Fax: 412-365-5766
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