Veterans Directed Home and Community Based Services

1. Veterans Directed Home and Community Based Services Kevin Foley Administration for Community Living (ACL) March 13, 2013 kevin.foley@acl.hhs.gov

2. Outline • Background • What is VD-HCBS? • Key Components and Status of VD-HCBS • Opportunity to serve Veterans and Caregivers • Lessons Learned • Q&A

3. Session Outline "For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives." - Secretary Kathleen Sebelius

4. ACL Anniversary "For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives." - Secretary Kathleen Sebelius

5. Growing Access to Participant Directed Programs ACL & VHA promote a person centered approach to serving all populations Evidence based practice Individuals exercise choice and control Options Counseling + flexible service budgets Driving culture change

6. Development of VD-HCBS • Partnership between ACL and VHA • Builds on CLP and ADRC development in Aging & Disability Networks • Meets goals of ACL to increase access and availability of person centered/participant- directed service systems to all populations • Assists VA to meet increasing demand for LTC and their goal to help Veterans stay in their own homes

7. VHA Philosophy for LTC • Provide Care in the least restrictive environment and whenever possible in home & community based settings • Nursing home care should be reserved for situations in which the veteran can no longer be safely maintained in the home

8. What is VD-HCBS? • The Veteran-Directed Home and Community-Based Services (VD-HCBS) program serves Veterans of any age who are at risk of institutional placement as well as their family caregivers. • VA Medical Centers (VAMCs) purchase these services on behalf of Veterans from: • State Units on Aging, • Area Agencies on Aging, and • Aging and Disability Resource Centers

9. What is VD-HCBS? • A Veteran in the program: • Receives an assessment and care planning assistance • Decides for themselves, or with a participant representative, what mix of goods and services will best meet their, and their family caregiver’s care needs • Manages a flexible, individual budget • Hires and supervises their own workers, including family or friends • Purchases items or services as needed to live independently in the community • Have financial management and support services which facilitate service delivery

10. What is VD-HCBS? • VAMCs will refer eligible Veterans (or must approve Veterans referred from other avenues) • Eligible Veterans: require a considerable amount of personal care assistance and/or experience difficulties with traditional agencies and desire to self direct their care • Agency will do an assessment, and with Veteran, develop a plan of services • Agency will provide ongoing support for Veteran including use and assistance with financial management services • VA expects that the Agency, at least performs: • Reassessments semi-annually in the first year • Conducts quarterly visits with the Veteran to monitor well-being • Agency must provide monthly invoices for reimbursement with estimated or actual expenses as agreed between VAMC and Agency

11. Planning for VD-HCBS • Completion of a Readiness Review is required. • Agency demonstrates ability to assist Veterans with: • Assessment and care planning • Development of a plan for a mix of goods and services that best meet the needs and preferences of each Veteran • Managing a flexible, individual budget • Hiring and supervising their own workers • Purchasing items and services to help them live independently • Working with an FMS to facilitate payment and service delivery • Utilizing traditional services as emergency back up • Note: Readiness Review completed with NRCPDS

12. Planning for VD-HCBS • Completing a Provider Agreement (ProVA) between VAMC and Network provider that outlines the policies and procedures for the program to include: • Payment for VD-HCBS is for a bundled package of services that includes planned purchases of services and goods, a “rainy day” fund, and an agency oversight fee for service coordination, agency administrative costs and financial management services • Approach to rates (case-mix and individual assessment) determined locally within caps set by VA Central Office • An initial assessment that is reimbursed separately from the budget, at a set rate, for each Veteran referred. • VA review of Veteran care through telephone contact, satisfaction surveys and periodically meeting with the agency and Veteran • Monthly invoices provided to the VAMC for reimbursement

13. Planning for VD-HCBS: Scalability Plan • Purpose: to guide program growth and trigger operational development • Includes: • Volume or quantity of people served by the infrastructure • Trajectory of quantity of people served (program expansion) • Key milestones • Mechanism to track progress to goal • Operational changes that need to occur as program grows

14. VD-HCBS NATIONAL STATUS

15. VD-HCBS: Status and Future Direction • 42 Operational Programs nationwide • Offered through VA Medical Centers (hospital systems) • 25 States and DC • 101 AAAs/ADRCs • Over 1400 Veterans Served to Date • 321 Under 60 years of age • 215 Served in OEF/OIF/OND • Continued Expansion • 6-10 new sites over next 6 months • VD-Respite

16. Milestones of VDHCBS Development VDHCBS Expands to 93 ADRC/AAA, 41 VAMCs and 24 States National Roll out of VD-HCBS & VD-Respite VDHCBS Expands to 81 ADRC/AAA, 33 VAMCs and 20 States VDHCBS Expands to 53 ADRC/AAA, 21 VAMCs and 15 States 2012 2011 VD-HCBS launched, 49 ADRC grants w/(5 year plans) 2010 51 states, 467 sites, 70% of pop. 2009 Nursing Home Diversion/Community Living Program 2008 ADRCs 47 states, 300 sites, 49% of pop. ADRCs 43 states, 147 sites, 30% of pop. 2007 ADRC ADRCs 24 states, 42 sites, 8% of pop. 2003 ADRCs12 states, 8 sites, 2% of pop.

17. Veteran-Directed Respite • New respite option for Veterans enrolled in the Program of Comprehensive Assistance for Family Caregivers (Stipend Program). • Participation Rate Expected to be High • Creative alternative to traditional respite care to meet the needs of the unique population being served. • Quick Start to Occur at Central Texas VAMC. • Requires Full & Successful Readiness Review by NRCPDS prior to start • VD-HCBS expansion possibilities through VDR.

18. VA Medical Centers in California

19. Lessons Learned from Operational Sites • You are never in this process alone. • When you need help ask: • ACL State Liaison, Darrick Lam • darrick.lam@acl.hhs.gov • ACL Project Officer, Elizabeth Leef • elizabeth.leef@acl.hhs.gov • NRCPDS, Sandy Barrett/Merle Edwards-Orr (readiness reviews) • sandragbarrett@sbcglobal.net • merle.edwards-orr@bc.edu • Lewin leads: Patrick Brady/Roger Auerbach • patrick.brady@lewin.com • rogerauerbach@yahoo.com • Or, ask to get connected with a colleague in an operational site.

20. Lessons Learned from Operational Sites • Keep in close contact with VAMCs: meet regularly and often, and whenever possible, in person. • VD-HCBS is a complex, multi-faceted program. Working through these components early with the VAMC will ensure a successful program once Veteran enrollment commences

21. Where can I learn More? http://www.adrc-tae.org/tiki-index.php?page=VDHCBStraining2011

22. National Quarterly VD-HCBS Webinars • ACL/VHA will be holding quarterly educational webinars • 6/12/13 • 9/18/13

23. Additional Resources • ACL.gov • http://www.acl.gov/Programs/Integrated_Programs/VeteranServices/Index.aspx • http://www.acl.gov/About_ACL/FederalInitiatives/VeteransCare.aspx • ADRC-TAE • http://www.adrc-tae.acl.gov/tiki-index.php?page=NewVDHCBS • National Resource Center for Participant Directed Services (NRCPDS) • http://www.bc.edu/schools/gssw/nrcpds/