Breaking barriers to patient care

To accomplish this, South Texas VA became the first health care system within our VISN to receive the Nationally Designated Telehealth Hub (NDTH) designation. And with its mission to provide clinical resource services through telehealth to Veterans, it is already meeting its goals of improving clinical outcomes and access to care.

With Telehealth, Veterans are able to connect to care with their VA care teams and specialists, and with the NDTH designation, South Texas VA is now able to take it a step further to provide access to care, not only for South Texas Veterans, but Veterans throughout the country.

Kimberly Oakman, Senior Nurse Advisor, Tele Palliative Care and Tele Long COVID Programs, is one of the clinicians leading this mission and shared how South Texas VA provides palliative care via telehealth unlike anyone else, highlighting the significant need to obtain this designation and provide this unique care to Veterans.

“I know with Palliative Care, there is some misunderstanding and I think there’s a chance for us to offer a service that supports Veterans and their caregivers and family that has just not existed,” she said. “To be able to provide this service for Veterans, the support and education is priceless. We’re excited for who we will be able to reach and provide services to.”

Palliative Care is a specialized form of medical care that provides symptom relief for people with serious illnesses. This care is delivered by an interdisciplinary team that focuses on improving the quality of life of Veterans living with a serious illness.

According to the Office of Connected Care, NDTHs enable the sharing of health care resources through telehealth across U.S. Department of Veterans Affairs medical facilities. Ultimately, this allows for NDTH health care professionals to deliver clinical services through telehealth to Veterans, upon request, from any VA Medical Center, no matter where that Veteran is located.

“We may be providing services for Veterans in Alaska. We just do not know where the need will come from but will work through time zones to meet the need,” Oakman said.

And just like Palliative Care, South Texas VA understood the need for Tele Long COVID care as Veterans began experiencing long-term effects from COVID, even years later.

Dr. Hanh Trinh, Medical Director for VISN 17 Nationally Designated Tele Long COVID and Tele Palliative Care, has worked alongside Oakman to ensure the correct structure was built to offer both health services, leading to the NDTH designation and improving access to this care nationwide.

“Here in South Texas, our Long COVID program is the oldest and the largest across VHA,” Dr. Trinh said. “We are now a NDTH to provide long COVID care, especially to rural facilities or any facilities that do not have long COVID access.”

Dr. Trinh highlighted how this designation will assist Patient Aligned Care Team providers as hundreds of thousands of Veterans have been diagnosed with COVID since 2020. Out of that group, approximately 4 to 7 percent of those Veterans will suffer from Long COVID.

“We now have the ability to proactively reach out to Veterans at these facilities, find them, and then help them with any underlying symptoms they may be having as it really impairs their quality of life,” she said.

While the Long COVID program has evolved since March 2020, the very first patient, Army Veteran Lorenzo Baker, is still grateful to this day for Dr. Trinh and her team.

Just one day after his wife, Erna, was admitted to a San Antonio hospital due to COVID, Baker was admitted to the COVID unit at Audie L. Murphy Memorial Veterans Hospital. Throughout his inpatient stay and discharge home, Dr. Trinh was steadfast in not only caring for Baker’s diagnosis, but ensuring he stayed on track to make a full recovery.

“They were compassionate. A lot of people don’t have compassion anymore,” Baker said, “but they were very compassionate and really helped me to get through all that stuff that was coming at me.”

And with that compassion, the South Texas VA team not only cared for him, but ensured that he was connected to Erna’s care team at an entirely different hospital. Sadly, Erna Baker lost her fight to COVID that Good Friday.

“If it weren’t for them, I would’ve been lost,” he said.

By VA medical centers agreeing to the Terms of Services of the NDTH, South Texas VA would be able to shoulder that burden with them to carry Long COVID and, at the same time, be able to introduce Palliative Care as it is known that introducing Palliative Care early on improves quality of life, Dr.Trinh emphasized.

“We want to do what we can for our Veterans,” she said.

A team of South Texas VA providers are ready to assist with both Palliative Care and Long COVID programs, ensuring that the resources are available as the need only grows.

Support for innovation

Oakman and Dr. Trinh both agreed that this designation would not have been possible without the support from local and regional leadership, who ensured there were no obstacles to achieving their goal.

“I think it goes to show the support we have from our leadership, to be able to build and create these types of programs to service other facilities that may not have the resources or may not find that these services are a priority, when in fact they are big issues that a lot of Veterans are suffering from,” Dr. Trinh said.

Without this support, Dr. Trinh emphasized that they would not have been able to push forward and become a national program to help bridge the gap and offer valuable resources.

Oakman shared that with her leadership’s support, she was able to attend Palliative Care education training courses at Harvard Medical School, obtaining knowledge and practices that have since carried over into South Texas VA’s program and fueled her excitement for the work she and her team are doing.

“We’ve had the support to do this, and I don’t know that other facilities are able to go through what it takes to actually run programs like this and see what is needed and we have a strong Palliative Care program here,” she said. “We’re fortunate for the support that we do have.”

Access to Rural Veterans

Oakman and Dr. Trinh understand the difficulty rural Veterans face with chronic medical conditions and having to make the trek to a medical facility. In addition, the strain COVID placed on clinical staff has not gone unnoticed.

“I can’t stress enough how fortunate we have been to have really great leadership, we have a fantastic team of physicians, nurses, psychologists, administrative staff who worked tirelessly for the last three, four years to make this program happen,” Dr. Trinh said. “We even had staff drive to Veterans’ homes in rural areas delivering COVID kits for the first three years.”

Clinical staff at South Texas VA worked tirelessly throughout the pandemic, giving of themselves without question to meet the needs of their patients. With this dedication, Oakman knew her staff would answer the call to improving access to care.

“Just seeing the need and being innovative and willing to look into it and overcome obstacles,” Oakman said. “Even with the staffing issues, we pulled two nurses from Long COVID, getting them trained up to be Palliative Care nurses so they could come over to help us launch the program.”

Dr. Trinh reflected on the Veterans who have received assistance through both programs, many who received care after being discharged from hospital stays. Through the hard work from both the Veterans and clinical staff, many were able to regain their health and are now roaming the world.

Baker emphasized how the Long COVID program medical team, consisting of two providers and five nurses, did an excellent job staying in touch with him and ensuring his vitals were strong and his health improved.

Over the course of 25 days, Baker reported his vitals three times a day: his temperature, oxygen levels, and blood pressure. And even though this could have become monotonous, he was thankful for the time they spent with him and cared for him.

“They kept my mind right, they kept me level, and on the ground,” he said.

Looking Ahead

This designation spotlights South Texas VA’s dedication to providing the best care possible to its Veterans, and breaking barriers in order to do so.  

“Dr. Trinh and I have been working on this designation for I don’t know how many months, long months, long hours to get the designation,” Oakman said. “We are just so happy now that we have the designation and this is what will allow us to start reaching out to the different VAs for these services and for us to start providing them to Veterans.”

And just as this team looks ahead to expanding its services, Baker continues to enjoy life, traveling across the country and reminiscent of the care he has received from South Texas VA.

“It was a lot of things that they did for me and I’ll be grateful for the rest of my life.”

Veterans who are interested in further reviewing their options for Tele Palliative Care or Tele Long COVID can speak with their Primary Care Providers. 

Veterans experiencing long COVID may access the following link for resources: https://www.va.gov/health-care/covid-19-vaccine/#LongCovid