Enhancing Veteran Care: The VA Fayetteville Coastal Health Care System's Home-Based Primary Care Program
By Corey Howard, Digital Media Manager
The VA Fayetteville Coastal Health Care's Home Based Primary Care (HBPC) program initiative is designed to provide comprehensive medical services directly to Veterans in their homes, especially those who are homebound or face substantial difficulties attending traditional medical appointments.
Through an interdisciplinary team approach, the program aims to enhance care coordination and improve the quality of life for Veterans across 19 counties in Southeastern North Carolina.
To align with the increasing Veteran population that the VA Fayetteville Coastal Health Care System has witnessed, the Home-Based Primary Care (HBPC) program has seen steady growth since its inception. Currently there are 270 Veterans enrolled in the HBPC program. Over the years, the program has expanded from one to five teams, including the addition of two teams within the last two years, enrolling an average of four patients per week.
At the core of the HBPC program lies an interdisciplinary team comprising Nurse Practitioners, Physician Assistants, Social Workers, Registered Nurses, Licensed Practical Nurses, Registered Dieticians, Rehabilitation Therapists, Pharmacists, and Advance Medical Support Assistants. Each team member plays a crucial role in providing holistic care tailored to the unique needs of each Veteran. Additionally, a psychologist is available to address the mental health needs of both Veterans and their caregivers, underscoring the program's commitment to comprehensive care.
The HBPC program encompasses a wide range of services, including primary care, medication management, nutritional counseling, physical rehabilitation, and social work support. Upon admission, each discipline conducts thorough assessments within the first 30 days, which culminate in a collaborative care plan that addresses the Veteran’s specific needs. This collective effort is regularly reviewed in interdisciplinary team meetings, ensuring that every team member, as well as the Veteran and their caregivers, have a voice in the ongoing care process.
One of the significant advantages of the HBPC program is its impact on hospitalizations. Data reveals a remarkable 50% reduction in hospital admissions for Veterans enrolled in the program, compared to their rates before admission. This not only leads to fewer inpatient days but also contributes to lower healthcare costs and enhances the overall well-being of the Veterans served.
LaTina Ross, MSW, LCSW and Program Director, emphasizes the importance of spending quality time with both patients and their caregivers. This allows for thorough assessments and a more personalized approach to healthcare that is often lacking in traditional settings due to time constraints. The HBPC program provides an alternative to institutional care, enabling immobile Veterans to remain at home while also reducing the risk of unnecessary hospital visits.
Caregivers are recognized as integral members of the HBPC team, receiving extensive support and education about their loved ones' medical needs. This includes resources on medication management, advanced care planning, and palliative care, which are crucial for optimizing quality of life and minimizing suffering. The program not only focuses on the Veterans but also prioritizes caregiver wellness, offering psychological services to help them maintain their own health as they provide care.
As the VA Fayetteville Coastal Health Care System continues to serve one of the nation's fastest-growing Veteran populations, the Home-Based Primary Care (HBPC) program plays a vital role for those that qualify. By prioritizing home-based care, this program addresses the immediate medical needs of Veterans while also fostering a sense of community and connection, which is essential for their overall well-being.
For those who think they or a Veteran they know could benefit from the HBPC program, the process begins by consulting with a Primary Care (PACT) Provider or reaching out to a PACT Social Worker. In doing so, they can explore the comprehensive and compassionate care that the HBPC program has to offer, ensuring that no Veteran is left behind in their healthcare journey.