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Geriatrics and Extended Care Program

The shared purpose of all Geriatric and Extended Care programs is to prevent or lessen the burden of disability on older, frail, chronically ill patients and their families/caregivers, and to maximize each patient's functional independence. Because the course of chronic illness varies, the health care needs of the chronically ill patient also change, requiring the services of one, some, or all Geriatrics and Extended Care services over time. Community Residential Care, VA Community Living Centers, Community Nursing Homes, and State Veteran Homes assist Veterans who are not able to live independently. Geriatric Research Education and Clinical Centers support the advancement and integration of research, education, and clinical achievements . Geriatric Evaluation & Management, Geriatric Primary Care, and Inpatient Respite offers interdisciplinary inpatient or outpatient services to elderly patients. Hospice and Palliative Care offer a continuum of comfort-oriented and supportive services provided in the home, community, outpatient, or inpatient settings for persons with advanced illness.

The Office of Geriatrics and Extended Care advances quality care for aging and chronically ill Veterans by providing policy direction for the development, coordination, and integration of geriatrics and long-term care clinical programs, and for the advancement of geriatrics and long-term care through research, education, and evaluation of new clinical models. Geriatrics and Extended Care site

Adult Day Health Care (ADHC)

Adult Day Health Care programs provide health maintenance and rehabilitative services to Veterans in a group setting during daytime hours. VA introduced this program in 1985. In 2008, VA operated 21 programs directly and provided purchased ADHC services at 113 VA medical centers. One state home provides ADHC services.

Adult Day Health Care is an outpatient day program that provides health maintenance and rehabilitative services to frail elderly and functionally impaired veterans. These services are delivered by a team of health professionals and support staff that strives to help participants and their caregivers develop the knowledge and skills necessary to manage care in the home. Geriatrics and Extended Care site

Community Residential Care

The community residential care program provides room, board, limited personal care and supervision to Veterans who do not require hospital or nursing home care but are not able to live independently because of medical or psychiatric conditions, and who have no family to provide care. The Veteran pays for the cost of the living arrangement. VA's contribution is limited to the cost of administration and clinical services, which include inspection of the home and periodic visits to the veteran by VA health care professionals. Medical care is provided to the Veteran primarily on n outpatient basis at VA facilities. Primarily focused on psychiatric patients in the past, this program will be increasingly focused on older Veterans with multiple chronic illnesses that can be managed in the home under proper care and supervision.

Provides health care supervision to eligible veterans not in need of hospital or nursing home care but who, because of medical and/or psychosocial health conditions are not able to live independently and have no suitable family or significant others to provide the needed supervision and supportive care. The cost of care is financed by the veteran's own resources. Placement is made in residential settings inspected and approved by the appropriate medical center but chose by the veteran. Geriatrics and Extended Care site

Geriatric Evaluation and Management (GEM)

Older Veterans with multiple medical, functional or psychosocial problems and those with particular geriatric problems receive assessment and treatment from an interdisciplinary team of VA health professionals. GEM services can be found on impatient units, in outpatient clinics and in geriatric primary care clinics. Currently VA operates 34 inpatient GEM programs and 64 GEM clinics.

GEM provides specialized services in an inpatient or outpatient setting where an interdisciplinary health care team performs multidimensional evaluations on a targeted group of elderly patients who will most likely benefit from these services. This team approach to assessment of the patient is followed by an interdisciplinary plan of care, including treatment, rehabilitation, health promotion and social service interventions. Geriatrics and Extended Care site

Geriatric Primary Care

A small percentage (about 2%) of the frail elderly Veterans who would otherwise receive their primary care in VA Primary Care Clinics are instead followed in Geriatric Primary Care, either in conjunction with a primary care provider or exclusively by the geriatrics-trained GPC team, where their more complex cases and involved medical histories can receive in-depth attention.

Outpatient visit for primary care provided to geriatric patients through coordinated, interdisciplinary provision of medical, nursing , psychosocial, allied health services for disease treatment and prevention, health promotion and education, referral for specialty, rehabilitation and other levels of care, follow-up and overall care management by the primary care provider and support team. The interdisciplinary primary care providers are trained in the management of healthcare problems associated with aging and the elderly. Geriatrics and Extended Care site

Geriatric Research, Education and Clinical Centers (GRECC)

These centers increase the basic knowledge of aging for health care providers and improve the quality of care through the development of improved models of clinical services

and a wide variety of educational activities targeting VA staff and trainees from the full range of health disciplines. Each GRECC has an identified one or more foci of research in the basic biomedical, clinical and health services area. Begun in 1975, there are now 20 GRECCs in all but two of VA's health care networks.

Geriatric Research Education and Clinical Centers (the GRECCs) are designed for the advancement and integration of research, education, and clinical achievements in geriatrics and gerontology into the total VA healthcare system. All of the GRECCs focus on various aspects in the quality of life and care for the aging veterans and are the forefront of leading edge research and education. GRECC site

Home-Based Primary Care

This Program (formerly Hospital Based Home Care) began in 1970 and provides long-term primary medical care to chronically ill veterans in their own homes under the coordinated care of an interdisciplinary treatment team. This program has led to guidelines for medical education in home care, use of emerging technology in home care and improved care for Veterans with dementia and their families who support them. In 2008, home-based primary care programs were located in 128 VA medical centers.

Home-Based Primary Care provides primary health care to homebound to patients that live in the community. HPBC is designed to serve the chronically ill through the months and years before death, providing primary care, palliative care, rehabilitation, disease management and coordination or care services. Home-Based Primary Care site

Homemaker and Home Health Aide (H/HHA)

VA began a program in 1993 of health-related services for service-connected Veterans needing nursing home care. These services are provided in the community by public and private agencies under a system of case management provided directly by BA staff. In 1999, this program was expanded to vocer all enrolled Veterans. VA purchased H/HHA services at 142 medical centers in 2008.

Provides clinical expertise in home and community coordination, provision of the continuity of care, and referral of patients to community agencies, VA programs, including skilled home health aide, and adult day health care. They also function as a liaision to community agencies, as well as monitor their services. Geriatrics and Extended Care site

Nursing Home Care

VA provides nursing home care through three venues: 132 VA owned and operated Community Living Centers (CLCs), formerly known as VA Nursing homes; Community Nursing Homes; or State Veterans Homes. VA contracts with over 2,500 Community Nursing Homes. The State Veterans Home program is growing and currently encompasses 122 nursing homes in 48 states and Puerto Rico. In fiscal year 2008, approximately 69 percent of VA's institutional nursing home care occurred in community and state veterans.

The Community Nursing Home Program has maintained two cornerstones: some level of patient choice in choosing a nursing home close to the veteran's home and family; and a unique approach to local oversight of CNHs. The CNH Program is responsible for monitoring the quality of care being provided in nursing homes. Geriatrics and Extended Care site

Purchased Skilled Home Care (PSHC)

Professional home care services are purchased from private-sector providers at every VA medical center. The professional home care services purchased covers mostly nursing services including medical social services, occupational therapy, physical therapy, skilled nursing and speech-language pathology. The program was formerly called "fee basis" home care.

Professional Skilled Home Care provides services that cover nursing services such as medical social services, occupational therapy, physical therapy, skilled nursing and speech-language pathology. The services can be provided from every VA medical center. Geriatrics and Extended Care site

Respite Care

Respite care temporarily relieves the spouse or other caregiver from the burden of caring for a chronically ill or disabled Veteran at home. In the past, respite care admission was limited to an institutional setting, typically a VA nursing home. The Veterans Millennium Health Care and Benefits Act expanded respitecare to home and other community settings, and home respite care was provided at 122 VA medical centers in fiscal year 2008. Currently, institutional respite car programs operate in 136 VA nursing home care units. Respite care is usually limited to 30 days per year.

Respite Care provides temporary relief, assistance and support to those veterans and their primary caregiver/family who are dealing with long- term disability/chronic illness in their home. Respite can be provided in an adult day facility to provide rest to the full-time caregivers, this option should not be confused with the provision of adult day care services to veterans for therapeutic activities to enhance their physical and emotional well-being. Geriatrics and Extended Care site