May 2011 Archives

"Discovery and Collaboration for Exceptional Health Care"
Research Week Celebrates VA Investigators' Achievements and Affiliations
May 3 2011
 

WASHINGTON (May 03, 2011) - The Department of Veterans Affairs (VA) is celebrating exceptional care for Veterans this week, May 2 - 6 as part of the nationally recognized Research Week. This year's theme, "Discovery and Collaboration for Exceptional Health Care," celebrates two crucial elements of VA research: dedicated follow-through on important research findings to optimize medical therapies for Veterans and others; and vital research and care collaborations between VA and academic institutions, other government agencies, and health-related industry.

"VA has a legacy of extraordinary achievement in research and development," said VA Secretary Eric K. Shinseki. "These achievements keep us on the cutting edge of health care and ensure we can provide, to all generations of Veterans, the very best care and services which they have earned through their service to the Nation."

"At the foundation of VA's collaborative system of world-class care is VA research-finding the answers to Veterans' needs and advancing the nation's medical knowledge," said VA Under Secretary for Health Dr.
Robert A. Petzel. "Our continued partnerships with our academic affiliates allow VA to expedite translation of research from bench to bedside, ensuring the best care for our Nation's Veterans."

In today's economic climate, the partnerships being recognized during Research Week are especially crucial for leveraging resources and maximizing the yield from research investments. "We are proud to join forces with others who share VA's passion for making life better for Veterans and all Americans," said VA Chief Research and Development Officer Dr. Joel Kupersmith. "Partnering with research organizations and academic partners means breakthrough findings come faster and will swiftly translate into life-improving therapies for our Veterans."

The theme of Research Week 2011 marks the 65th anniversary of Policy Memorandum No. 2, an historic agreement which allowed VA to affiliate with medical schools. VA and the Association of American Medical Colleges (AAMC) have further strengthened their working relationship through a data and information-sharing agreement. The new agreement standardizes data security requirements and processes across institutions, helping to speed the pace of research and introduction of new treatments into practice. "This agreement is the latest example in the VA's rich, and productive history working with the nation's medical schools to bring about new advances," said AAMC Chief Scientific Officer Ann C. Bonham, who holds a doctorate. "At the same time, it requires adherence to the highest standards of privacy protection."

In addition to Research Week activities nationwide at VA medical centers and partner organizations, on May 5 at VA Central Office in Washington, DC, distinguished speakers will present their perspectives on VA's achievements in health research. Presenters will include several Veterans, as well as Kupersmith; VA Chief of Staff John Gingrich; and Deputy Under Secretary for Policy and Services Madhulika Agarwal, MD, MPH. Guest speakers will include Bonham; Col. Greg Gadson, Army Wounded Warrior Program Commander; E. Albert Reece, MD, PhD, MBA, Vice President for Medical Affairs and Dean of the University of Maryland School of Medicine; Gregg Zoroya, USA Today reporter; and Stephen Cochran, Veteran and country music singer-songwriter, who will moderate a panel of Veterans discussing their participation in VA research.

Information about Research Week activities being held at VA Central Office and across the country is available at http://www.research.va.gov/researchweek


VA to Take Applications for New Family Caregiver Program

VA Implementing Enhancements to Existing Services

for Veterans and Their Caregivers
May 4. 2011
 

WASHINGTON - Today, the Department of Veterans Affairs (VA) published the interim final rule for implementing the Family Caregiver Program of the Caregivers and Veterans Omnibus Health Services Act 2010. This new rule will provide additional support to eligible post-9/11 Veterans who elect to receive their care in a home setting from a primary Family Caregiver.

"We at VA know that every day is a challenge for our most seriously injured Veterans and their Family Caregivers," said VA Secretary Eric K.
Shinseki. "I know many Veterans and their Family Caregivers have been
waiting anxiously for this day and I urge them to get their applications in as soon as possible so they can receive the additional support they have earned."

On May 9, staff in VA's Office of Care Management and Social Work will open the application process for eligible post-9/11 Veterans and Service members to designate their Family Caregivers.

Additional services for primary Family Caregivers of eligible post-9/11 Veterans and Service members include a stipend, mental health services, and access to health care insurance, if they are not already entitled to care or services under a health care plan. Comprehensive Caregiver training and medical support are other key components of this program.
The program builds on the foundation of Caregiver support now provided at VA and reflects what families and clinicians have long known; that Family Caregivers in a home environment can enhance the health and well-being of Veterans under VA care.

Starting May 9th, Veterans may download a copy of the Family Caregiver program application (VA CG 10-10) at www.caregiver.va.gov. The application enables the Veteran to designate a primary Family Caregiver and secondary Family Caregivers if needed. Caregiver Support Coordinators are stationed at every VA medical center and via phone at
1-877-222 VETS (8387) to assist Veterans and their Family Caregivers with the application process.

"Providing support to Family Caregivers who sacrifice so much to allow Veterans to remain at home surrounded by their loved ones, is very important to us at VA. We offer a range of Caregiver support services including training, counseling and respite care to ensure that our caregivers have the tools and support they need to continue in their care giving role," said Deborah Amdur, VA's Chief Consultant for Care Management and Social Work. "We appreciate the patience, support and assistance we have received from Veterans, Veterans Service Organizations, and the greater Caregiver community in shaping this program and bringing this new VA program to our wounded warriors and their dedicated Family Caregivers."

Caregivers for Veterans of all eras are eligible for respite care, education and training on what it means to be a caregiver, how to best meet the Veteran's care needs, and the importance of self-care when in a care giving role. The full range of VA services already provided to Caregivers will continue, and local Caregiver Support Coordinators at each VA medical center are available to assist Family Caregivers in identifying benefits and services they may be eligible for. The Caregiver Support Coordinators are well versed in VA programs and also have information about other local public, private and non-profit agency support services that are available to support Veterans and their Family
Caregivers at home.

VA programs for Veterans and their Family Caregivers include:

 In-Home and Community Based Care: This includes skilled
home health care, homemaker home health aide services, community adult day health care and Home Based Primary Care.

Respite Care: Designed to relieve the Family Caregiver
from the constant challenge of caring for a chronically ill or disabled Veteran at home, respite services can include in-home care, a short stay in one of VA's community living centers or an environment designed for adult day health care.

Caregiver education and training programs: VA currently
provides multiple training opportunities which include pre-discharge care instruction and specialized caregiver programs in multiple severe traumas such as Traumatic Brain Injury (TBI), Spinal Cord Injury/Disorders, and Blind Rehabilitation. VA has a Family Caregiver assistance healthy living center on My HealtheVet,  http://www.myhealth.va.gov , as well as caregiver information on the VA's main Web page health site; both Websites include information on VA and community resources and Caregiver health and wellness.

Caregiver support groups and other services: Family
Caregiver support groups, offered in a face to face setting or on the telephone, provide emotional and peer support, and information. Family Caregiver services include family counseling, spiritual and pastoral care, family leisure and recreational activities and temporary lodging in Fisher Houses.

Other services: VA provides durable medical equipment
and prosthetic and sensory aides to improve function, financial assistance with home modification to improve access and mobility, and transportation assistance for some Veterans to and from medical appointments.


VA to expand caregivers program
May 3, 2011

WASHINGTON (AP) — The Veterans Affairs Department reversed course Tuesday and said it will make sure more caregivers of severely disabled Iraq and Afghanistan veterans can receive the support they need to help their wounded relatives.

President Barack Obama signed a law in May of last year that provided a monthly stipend, mental health help and health insurance to family members who provide around-the-clock care to these veterans.

But when the VA announced earlier this year how the caregivers program would work, advocates and congressional members said it helped fewer families than they had expected. Among those who likely were not eligible were Sarah and Ted Wade, who stood with Obama at the bill signing. Ted Wade lost his right arm and sustained a traumatic brain injury in a roadside bombing in Iraq in 2004 while serving with the 82nd Airborne Division.

The VA now says about 3,500 families will be eligible, which is how many Sen. Patty Murray, the chairman of the Senate Veterans' Affairs Committee, has said Congress wanted. Under the earlier plan, the VA said about 10 percent of the critically wounded from the recent conflicts would be eligible, which was about 850 veterans. The plan will cost about $770 million over five years.

Under the new plan, veterans eligible are those who sustained a serious injury who are in need of personal care services. But, families no longer have to show that the veteran would go to an institution without the caregiver's help.

The VA says it will begin taking applications on May 9 and the monthly stipend will be ready by July. To participate, the caregiver must agree to a home visit and some other requirements.

Deborah Amdur, the VA's chief consultant for care management and social work, said VA officials considered feedback in making decisions on how to implement the program, and she feels confident in how it will be rolled out.

"We have worked very hard to make this a success," Amdur said.

Murray said she'd been so concerned about the original plan that she'd taken up the issue with Obama. She said she's pleased that the administration changed its eligibility requirements.

"The VA correctly has responded in a positive way," Murray said.

The enhanced benefits are only for caregivers of veterans from the recent wars. But the VA has said it is improving other existing programs for caregivers of veterans from all eras. In February, it created a national caregivers support hotline that has received about 5,000 calls.

Veterans' service organizations had wanted additional support for all caregivers of veterans, but Congress was not able to come up with enough money to do so. The law instructs the VA to report to Congress within two years about the possibility of providing the enhanced benefits to all caregivers.


The Million Veteran Program: VA's Genomics Game-Changer Launches Nationwide
May 5, 2011

 

WASHINGTON (May 5, 2011) - An unprecedented Veterans Affairs (VA) research program that promises to advance the sophisticated science of genomics goes national today.

"It is my honor," said Secretary of Veterans Affairs Eric K. Shinseki, "to join with so many fellow Veterans in keeping VA at the leading edge of genomics research. This innovative research program will support VA's mission to provide Veterans and their families with the care they
have earned."

Dr. Robert A. Petzel, VA's Under Secretary for Health said, "The Veterans Affairs Research and Development Program has launched the Million Veteran Program, or MVP-an important partnership between VA and Veterans to learn more about how genes affect health, and thus, transform health care for Veterans and for all Americans."

The Million Veteran Program is a trailblazing VA effort to consolidate genetic, military exposure, health, and lifestyle information together in one single database. The database will be used only by authorized researchers with VA, other federal health agencies, and academic institutions within the U.S.-in a secure manner-to conduct health and wellness studies to determine which genetic variations are associated with particular health issues. By identifying gene-health connections, the program could consequentially advance disease screening, diagnosis, and prognosis and point the way toward more effective, personalized therapies.

Launched in January at a single VA medical center, MVP is expanding to achieve the goal of national participation by Veterans receiving VA care over the next 5 to 7 years. Among those participating are VA Secretary Eric K. Shinseki, Deputy Secretary W. Scott Gould, and Chief of Staff John R.
Gingrich.

Patient safety and information security are the top priorities in MVP and all VA research initiatives. To protect Veterans' confidentiality, blood samples containing genetic material and health information collected for MVP will be stored in a secure manner and labeled with a barcode instead of personal information. The researchers who are approved to access samples and data will not receive the name, address, social security number or date of birth of participating Veterans.
Importantly, the data will not move to the researchers, but rather researchers will come to the data-through the VA GenISIS computing environment-to increase security.

The program has been developed in close coordination with the VA Genomic Medicine Program Advisory Committee-comprised of private and public health, scientific, legal experts in the field of genetics and Veteran representatives-which advises the Secretary of Veterans Affairs, and partners such as Veterans Service Organizations, the Department of Defense, and the National Institutes of Health.

VA is superbly positioned to conduct complex genomics research thanks to its large, diverse, and altruistic patient population and other unrivaled assets. "We have a research establishment that is embedded in an integrated health care system with a state-of-the-art electronic health record, fully equipped genomic laboratories with the latest in technology, and top-caliber investigators-most of whom also provide direct patient care," said Dr. Joel Kupersmith, VA's chief research and development officer. "The merger of these distinct attributes-with the Veteran as a partner-make VA uniquely able to conduct this ground breaking genomic research."

By enabling researchers to analyze and compare the DNA and other genetic materials of a population of Veterans potentially a million-strong, MVP represents a powerful tool in genetics research. For more information about MVP-including the stringent safeguards in place to protect the privacy and confidentiality of those Veterans who take part-visit www.research.va.gov/MVP.
 


REACHING Out to Alzheimer Families
May 7, 2011
 

Robin Weidberg, daughter of Navy Veteran Raymond Boop, serves him a classic southern lunch of fried chicken and sweet tea.
“You deserve a break today,” goes the famous advertising slogan.

Researchers and clinicians may not call it a “break” — an “intervention” would be the more likely term — but that’s exactly what teams at VA sites nationwide are now preparing to deliver to thousands of Americans who have one of the most stressful and demanding jobs around.

The program is called REACH, short for Resources for Enhancing Alzheimer’s Caregiver Health. It’s now being implemented at VA sites nationwide, with the goal of providing much-needed support for a beleaguered caregiver population.

Reducing Caregiver Risk

About 80 percent of care for those with dementia is provided by family caregivers, but these devoted family members often lack the skills to manage troubling patient behaviors and their own stress. As a result, they can be at risk for depression, anxiety and other health problems. And their aging loved ones with Alzheimer’s are less likely to be able to remain at home.

The REACH effort began with two studies sponsored by the National Institute on aging and National Institute of Nursing Research and conducted by investigators with VA and several universities. The researchers tested a six-month intervention designed to ease caregiver stress. It included 12 individual sessions in the home and by telephone, complemented by 5 telephone support-group sessions. The focus is on education, support and skills-building.

In the REACH model, trained “interventionists” teach family caregivers how to reduce stress, solve problems and manage difficult behaviors by their family member. Role-playing and other strategies are used to develop coping skills. A caregiver notebook, written in very easy-to-understand language, covers dozens of topics, ranging from the physical care of the person with Alzheimer’s to emotional and communication issues.

“REACH VA is designed for caregivers who are highly stressed,” says Jennifer Martindale-Adams, EdD, an investigator with the Memphis VA Medical Center and the Department of Preventive Medicine at the University of Tennessee Health Science Center.

“It is easy for staff to use because it is structured, with a protocol and scripts. It meets the needs of caregivers and Veterans because it is targeted to their individual concerns through a risk appraisal.”

The material is tailored to family members based on assessments of where they need the most help. For example, some caregivers might simply need more knowledge about available resources or Alzheimer’s symptoms, while others need to learn how to reframe their emotional responses.

“Risk priority assessment is the most innovative part of the program,” says Linda O. Nichols, PhD, a health educator and lead investigator for REACH. “Targeting the intervention to the caregiver’s needs and not just to the behavior problems of the patient helps to individualize the program and to focus on high-risk areas first.” She is also with the Memphis VA and the University of Tennessee.

Family members often become caregivers to disabled or ailing Veterans.
VA Acts on Positive Study Findings

Findings from the REACH studies showed improvements across many areas. Caregivers reported less “burden” and depression, and improved emotional well-being overall. They also reported gains in the areas of self-care and healthy behaviors, social support, and management of problem behaviors on the part of their loved ones with Alzheimer’s disease. Plus, they gained an hour a day of time that was not consumed with caregiving duties.

“The intervention provided that most scarce of caregiver commodities, time,” wrote Nichols and coauthors in a 2008 journal report.

“We think the biggest outcome was in the increase in perceived free time of one hour,” adds Martindale­Adams. “The extra non-caregiving time could allow the caregivers to do what they wanted.”

Moreover, the extra soul-nourishing hour came relatively cheap — at a cost of about $5 per day for each caregiver — according to an analysis by the Memphis group. “We showed that you can do behavioral interventions,” says Martindale-Adams. “There are a lot of people who have said they won’t work due to cost.”

Based on these positive results, in 2007 VA began a “translation project” called REACH VA, designed to parlay REACH into an ongoing program to help caregivers of Veterans with Alzheimer’s. The first step was showing how the program could work on a wide scale in VA. The six-month intervention was delivered at 24 sites in 15 states through VA’s Home Based Primary Care programs. The Memphis VA Medical Center coordinated the effort, providing training to the clinical sites, certification of staff and evaluation of the results.

By and large, the 127 caregivers who took part in REACH VA — most of them spouses of Veterans -reported improvements similar to those seen in the earlier research. Significantly, 96 percent said the intervention program should be provided by VA to all caregivers. The full results were reported earlier this year in the Archives of Internal Medicine.

REACH "interventionists" teach family caregivers how to handle the stress and work of caring for their family member.
“Most rewarding aspect of my work with VA”

Saudia Major, PhD, a clinical psychologist with the VA Ann Arbor Healthcare System, has been involved with REACH VA since late 2008.

“It’s been one of the most rewarding aspects of my work here,” she says. “When I joined the Ann Arbor VA and began making home visits, I experienced a frequent sense of sadness when I observed the caregivers. These people, often times spouses of the Veterans, appeared depressed, teary, isolated, and usually in poor physical condition due to self-neglect. I found that some caregivers would attempt to monopolize my time during home visits, understandably due to lack of support, and I would have to spend a good bit of time redirecting them and my focus to the Veteran.”

The results from REACH, she says, can often be dramatic.

“It gives caregivers a sense of validation, helps them realize they are not alone, and that their needs have been heard. With this comes an increase in self-esteem and self-confidence. We see an improvement in their caregiving abilities and skills and then we observe declines in depression and stress. I’ve had a couple of caregivers tell me that that they felt that I, and the REACH VA program, saved their lives.”

Shelby Nemeth, one of the caregivers with whom Major has worked, says she feels “blessed” by the REACH program.

Her husband of 53 years, 85-year-old Lawrence, a Purple Heart Veteran of the Battle of the Bulge, has had Alzheimer’s since 2003. She has looked after him around the clock ever since.

“He has his good days and his bad days,” she says. “No, he doesn’t recognize me. But, he’s comfortable.”

When Major and her team offered to enroll Nemeth in REACH and some related respite services, at first she thought she would feel guilty about not being there all the time for her husband. “Then I realized that my being healthy, letting go of some of that stress, was not only good for me, but it was just what Lawrence needed, for me to be strong enough to take care of him.”

For Nemeth, preserving her own health was no small task: a few years ago, she suffered a heart attack and underwent a quadruple bypass. She relied on her and Lawrence’s children to help care for him while she recovered.

“I am so grateful to the VA for the REACH program,” says Nemeth. “I would absolutely recommend it to other Veteran families.”

Now, REACH VA is being rolled out on a national basis through VA’s Home-Based Primary Care programs. Training has started on a wide scale this year and will continue over the next few years.

“The Home-Based Primary Care staff have been amazing in the translation,” notes Nichols. “They do the work because they see a need.”

The needs of other Veterans and their caregivers — outside the Alzheimer’s community — will be addressed as REACH VA is modified for spinal cord injury and traumatic brain injury.

Says Nichols, “We have had wonderful support from VA in moving REACH from research to a program that will be available to caregivers around the country.”
 


VA Partners with Easter Seals to Train Family Caregivers of Wounded Warriors
May 9, 2011
 

Applications for Services and Training Taken Nationwide Starting Today

WASHINGTON (May 9, 2011) - The Department of Veterans Affairs (VA) and Easter Seals formally announced a partnership to provide comprehensive Caregiver Training to Family Caregivers of eligible post-9/11 Veterans as authorized by the Caregivers and Veterans Omnibus Health Services Act of 2010.

"We at VA are committed to providing the Family Caregivers who share our sacred duty to care for those 'who have borne the battle' with the best services available," said Secretary of Veterans Affairs Eric K.
Shinseki. "We are very pleased to partner with a renowned organization
such as Easter Seals in developing the best possible training program for Family Caregivers. Throughout its long history, Easter Seals has demonstrated its strong commitment to supporting our Nation's Military,
Veterans and their families."

"Easter Seals is proud to share our expertise and knowledge with this important group of Family Caregivers, taking care of loved ones who returned home with serious injuries after their post 9/11 service to our nation," explained James E. Williams, Jr., president and chief executive officer of Easter Seals. "We are honored to help these Veterans and their families."

Starting today, Family Caregivers and Veterans can apply for services authorized under a VA interim final rule that was published on May 5.
Eligible Family Caregivers of eligible post-9/11 Veterans will receive comprehensive training developed by Easter Seals in collaboration with VA clinical experts. It is part of a package of new services that also include a monthly stipend, mental health services and access to medical care under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), if the primary Family Caregiver is not entitled to care or services under a health plan contract.

Easter Seals has been helping people with disabilities and special needs, and their families, live better lives for more than 90 years.
From child development centers to physical rehabilitation and job training for people with disabilities, Easter Seals offers a variety of services to help people address life's challenges and achieve personal goals.

Family Caregivers of eligible post-9/11 Veterans will have a choice of how to receive their training. Options will include traditional classroom training, online learning or a correspondence course. All Family Caregivers will be expected to complete training as part of the preparation to start receiving other services under the new program. The first training courses are expected to start in June, and monthly stipends, which are backdated to the day applications are formally submitted, could begin as early as July.

Veterans may download a copy of the Family Caregiver program application at www.caregiver.va.gov. The application enables the Veteran to designate a primary Family Caregiver and secondary Family Caregivers.
Caregiver support coordinators are stationed at 153 VA medical centers and available by phone at 1-877-222 VETS (8387) to assist Veterans and Family Caregivers with the application process. Caregivers of Veterans from all eras are also encouraged to use the website and support line to explore more than two dozen other services VA provides Caregivers.

# # #

About Easter Seals

Easter Seals is a non-profit provider of services for individuals with autism, developmental disabilities, physical disabilities and other special needs. For more than 90 years, it has been offering help to children and adults living with disabilities and to the families who love them. Through therapy, training, education and support services, Easter Seals assists people with disabilities to live, learn, work and play. If you would like more information on Easter Seals, visit the Easter Seals website at www.easterseals.com


Court says Congress and president failed to help veterans
May 10, 2011

NEW YORK (Reuters) - Accusing Congress and the president of neglecting to take appropriate action to save veterans' lives, a federal appeals court called for drastic improvements to the Department of Veterans' Affairs mental health care system.

The 9th Circuit U.S. Court of Appeals, in a 104-page decision issued on Tuesday, cited the failure of the political branches to address what it called the VA's "egregious problems" and "unchecked incompetence" in delivering mental health services to veterans.

That failure, the three-judge panel held, violated the veterans' due process rights under the U.S. Constitution.

The court cited examples of veterans with severe depression or post-traumatic stress disorder having to wait over eight weeks for mental health referrals, with some committing suicide in the interim.

Over 84,000 veterans are on waiting lists for mental health care, the court wrote, with no procedure for challenging the delays. The court added that those delays can mean "the difference between life and death," with an average of 18 veterans committing suicide every day.

Two nonprofit organizations, Veterans for Common Sense and Veterans United for Truth Inc, had sued the VA in 2007 over the government's "shameful failures" to care for wounded veterans. The California district court dismissed the groups' claims, finding that the court lacked jurisdiction to implement or meddle with the agency's mental health plan.

The three-judge panel comprised of 9th Circuit judges Alex Kozinski, Procter Hug and Stephen Reinhardt acknowledged that the court's intervention in the agency's affairs was an "extraordinary step" and one better suited for Congress or the president.

In the opinion, written by Reinhardt, the panel concluded that the political branches had "so completely and chronically failed" to respect veterans' rights that the court had to intervene.

"No more veterans should be compelled to agonize or perish while the government fails to perform its obligations," the opinion said.

The VA did not immediately respond to a request for comment.

Heather Moser, a lawyer for the veterans' groups, said the decision was "monumental" for recognizing that veterans' have a constitutional right to mental health care in a timely manner.

The 9th Circuit panel sent the case back to the lower court to determine what changes are necessary to ensure that veterans in need of mental health care receive prompt treatment and those with urgent problems receive immediate help.

(Reporting by Terry Baynes; Editing by Jerry Norton)


Untouchable! Vets’ $52 Billion Health Care Plan
By Merrill Goozner, The Fiscal Times
May 12, 2011
 

This story comes from our partner

Rep. Jack Kingston, a Georgia Republican, leaned forward in his seat at a Wednesday armed services appropriations hearing and practically begged the Pentagon’s top health care official for tips on how to explain a proposed hike in military retiree health care fees to constituents and the news media back home.

“There is this pressure for free health care for life for veterans,” explained Kingston, who represents many veterans in his Savannah area district. Jonathan Woodson, the assistant secretary of defense for health affairs, replied that “Congress never meant for the health care benefit” for 5.3 million military retirees and their family members “to be entirely free.”

The exchange illustrates how difficult it is for legislators on Capitol Hill to make even minor changes to military budgets that have come to be seen as largely untouchable – even a small adjustment to a copayment requirement in a health insurance program that has turned out to be a sweet deal for military pensioners.

Members of the military can retire after 20 years with a full pension and heavily subsidized health care for life. It is one of the chief drivers of rapidly rising military health care spending, which has tripled in the past decade to more than $52 billion a year.

It’s not the only factor driving higher military health spending, to be sure. The system also provides care for the health needs of the military’s 3.8 million active duty personnel and family members. After ten years of war, that health care system is beset with a host of problems ranging from the special needs of tens of thousands of severely wounded veterans of Iraq and Afghanistan; to the 20,000 traumatic brain injuries incurred every year; to the uncounted tens of thousands more suffering from post traumatic stress disorder.

In addition, the military, like the rest of society, is trying to figure out ways to slow down the rapidly rising cost of care for those it covers both in and out of the military. In one effort to combat that problem, the Obama administration in its 2012 budget calls for increasing retirees’ co-insurance, currently $230 a year for individuals and $460 for families, by 13 percent; indexing it for medical inflation; and lifting co-pays on doctor and hospital visits and drugs. This would mark the first increase in these charges since 1996, according to Woodson.

It’s an approach to holding down costs that has long been used by the private sector with little success. The amount of money raised through the higher co-pays is small, and it rarely leads people to stop using marginally effective or unnecessary care.

The proposal drew immediate fire from veterans groups, which in turn received support from members of both political parties. A House Armed Services subcommittee on military personnel two weeks ago postponed the fee increases for at least one year on TRICARE Prime, the health maintenance organization-like plan that is the largest military health care program. However, with the Pentagon under pressure to cut costs, moves are underway in Congress to restore the fee increase for next year, but index its annual increase to the cost-of-living, rather than medical inflation, which is far higher.

Still, even that is causing queasiness among legislators leery of crossing veterans, whose entitlements remain sacrosanct. They’re getting an earful from groups like the Veterans of Foreign Wars, whose chief spokesman, Joe Davis, told The Fiscal Times on Wednesday that “we don’t want any increases and we don’t want it tied to any outside factor, not COLA, not anything.

When asked how he could justify his position when everyone else, including other government employees, had seen their health care co-pays and co-insurance rise in recent years, he replied: “How can you put military people and the rest of society on parity, especially after ten years of war. This is a health care benefit that people were promised by their recruiters. We paid for that benefit up front by 20 or more years in the military.”

The military is trying several other tactics to reduce its soaring health care costs. In recent years, it has funneled more of its retirees into coordinated care programs, which hopefully will better manage the costs of ex-soldiers and their family members with chronic diseases. They’ve also given special prices for people who use a mail order house for pharmaceuticals, which can substantially lower cost. The military already uses a preferred drug list, known as a formulary, which imposes significantly higher co-pays for drugs not on the list.

“We are proposing minor changes to out-of-pocket costs that are exceptionally modest, manageable and remain well below the inflation-adjusted out-of-pockets costs enjoyed in 1995, when TRICARE Prime was first introduced,” Woodson testified before the House Armed Services Appropriations subcommittee on health. The proposed increase amounts to $2.50 per month for single retirees and $5 a month for retiree families.

Caring for the rising number of seriously wounded soldiers from the wars in Afghanistan and Iraq is also driving military health care costs skyward, and will for years. The military now employs 4,280 staff in 29 “Warrior Transition Units” to care for the 10,011 wounded, ill or injured soldiers still in the military. More than 40,000 wounded soldiers have passed through the program since June 2007, with just 16,000 returning to their former units.

The military is also grappling with a rising tide of substance abuse cases, often related to chronic use of prescription pain medications initially given after being wounded. Lt. General Eric Schoomaker, the surgeon general of the army, told the subcommittee that immediate treatment of battlefield injuries with opium-derived drugs and other painkillers can reduce incidences of post-traumatic stress disorder by 50 percent.

But the army is now looking at alternatives for reducing use of the drugs for chronic pain, such as acupuncture, yoga, and biofeedback, Schoomaker said. However, it could wind up increasing the military health care bill. “There is a good evidence-based case” for these approaches,” he said. “But to be perfectly blunt, the reimbursement system is not adequate.”

Meanwhile, the army is also in the midst of a major five-year, $5 billion program to rebuild its far-flung hospital network, both on domestic bases and abroad. It has asked for a 30 percent increase in its construction budget to $1.3 billion for next year.

Heading the list is the total reconstruction of the Landstuhl Medical Center in Germany, which has served as the way station for wounded soldiers from the Middle East but also serves the 170,000 U.S. military personnel and their families stationed in that country. The 122-bed project heads the wish-list for this year’s appropriation.
While some critics seeking to pare military budgets have called for shutting down the German bases, which have housed 50,000 U.S. troops and their families since the end of World War II, the army is digging in for the long haul. “This is a very important time for rebuilding and replacing our facilities,” Schoomaker said about the hospital projects.

 


Post-traumatic Stress Disorder (PTSD) App Helps Thousands
May 16, 2011
 

WASHINGTON (May 17, 2011) - The PTSD Coach smartphone application (app), launched in April by the Department of Veterans Affairs (VA) and the Department of Defense (DoD), has already helped more than 5,000 users connect with important mental health information and resources.

"This new tool is about helping Veterans and Servicemembers when and where they need it," said Secretary of Veterans Affairs Eric K.
Shinseki. "We are encouraged so many have already downloaded this resource and hope many more will utilize this convenient tool to access VA services."

Since its launch, the PTSD Coach app has been downloaded by thousands of individuals. While 96 percent of the users so far are located in the United States, the app has also been downloaded in 25 other countries.
The app lets users track their PTSD symptoms, links them with public and personalized sources of support, provides accurate information about PTSD, and teaches helpful strategies for managing PTSD symptoms on the go.

Currently, the PTSD Coach app has received perfect customer review scores on the iTunes App Store. Comments from Veterans and family members are overwhelmingly positive and one user describes the app as "a must for every spouse who has a family member with PTSD." Professionals have sent positive reviews, suggestions and offers to collaborate on research evaluating the PTSD Coach app.

The app has also already proven to be a useful tool for the staff at the Veterans Crisis Line. Within the first two hours of the app's official launch, the Crisis Line staff were contacted by a distressed Veteran who reported being instructed by the app to call the crisis line and was subsequently given an appointment at the local VA medical center.
Crisis Line staff have begun to regularly recommend this resource to callers.

The app is one of the first in a series of jointly-designed resources by the VA National Center for PTSD and DoD's National Center for Telehealth and Technology to help Servicemembers and Veterans manage their readjustment challenges and get anonymous assistance. Given the popularity of mobile devices, VA and DoD hope to reach tens of thousands of Veterans, Servicemembers, and their family members with the new suite
of apps.

Information on the PTSD Coach app is on the VA's National Center for PTSD Website: http://www.ptsd.va.gov/public/pages/PTSDCoach.asp. More apps from DoD's National Center for Telehealth and Technology <http://t2health.org/apps> can be found at:
http://www.t2health.org/apps.
 


VA Processing Hundreds of Applications for New Family Caregiver Benefits in First Week
May 18, 2011

WASHINGTON (May 18, 2011)- In the first week for open applications, the Department of Veterans Affairs (VA) has assisted more than 625 Veterans, Servicemembers and their Family Caregivers in applying for new services under the Caregivers and Veterans Omnibus Health Services Act 2010.

"We are off to a good start having helped hundreds to apply, but we know there are thousands more who will qualify and need to apply today," said
Secretary of Veterans Affairs Eric K. Shinseki. "I encourage eligible
Veterans and their Family Caregivers to apply now to receive the benefits they have earned."

New services for primary Family Caregivers of eligible post-9/11 Veterans include a stipend, mental health services, and access to health care insurance, if they are not already entitled to care or services under a health plan. The stipend portion of this service will be backdated to the date of the application. Comprehensive Caregiver training and medical support are other key components of this program.

VA began processing applications for eligible post-9/11 Veterans and Servicemembers to designate a Primary Family Caregiver on May 9, 2011.
On top of receiving the 625 plus applications, Caregiver Support Coordinators have also assisted nearly 1,200 other Caregivers in finding more than two dozen other Caregiver benefits VA provides.

Applications can be processed by telephone through the Caregiver Support Line at (855) 260-3274, in person at a VA medical Center with a Caregiver Support Coordinator, by mail or online at www.caregiver.va.gov with the new Caregiver Application (VA Form 1010-CG). The website application also features a chat option that provides the Family Caregiver with a live representative to assist in completing the application form.
 


Women on war front more likely to get post-traumatic stress disorder than men, study finds

By Shari Roan, Los Angeles Times

12:35 PM PDT, May 19, 2011

 
 

Women deployed in the wars in Iraq and Afghanistan are emerging as a group especially vulnerable to post-traumatic stress disorder, researchers reported this week at the annual meeting of the American Psychiatric Assn.

More than 230,000 women have served in Iraq and Afghanistan since 2001, according to a Los Angeles Times story published in April on PTSD among female military personnel. Women, however, have been denied insurance coverage for treatment for PTSD at a higher rate than men because of a former stipulation that required combat experience to qualify for the benefit. Under rule changes enacted last year, any veteran deployed to a combat zone can seek care for PTSD. But the story noted that VA officials know little about the scope of the problem among women.

In the study, presented this week, researchers studied 922 National Guard members -- including 91 women -- under mandatory deployment to Iraq in 2008. The guard members were screened using mental-health measures before deployment and three months after deployment. The study found that women were much more likely than men to meet the criteria for PTSD after returning home -- 18.7% of women had PTSD compared with 8.7% of men. There were no significant differences between men and women in their level of combat exposure.

The women were much less likely to feel well-prepared for combat before deployment and were more likely to report a lack of unit cohesion during deployment. Unit cohesion is the mutual support and bonds of friendship among members of a military unit. Another study presented at the APA meeting found such cohesion is emerging as a major factor in determining the mental-health effects of combat on troops.

U.S. Army researchers surveyed 1,600 soldiers from two combat brigades who had been deployed once. They found that unit cohesion was a key factor in whether soldiers developed thoughts of suicide."Despite the evolving role of women in the military, few studies have examined gender-relevant issues in combat deployment," wrote the authors of the study on PTSD among women, led by the Department of Veterans Affairs-New Jersey Health Care System. "This study suggests that women may be at greater risk than men of developing combat-related PTSD in part because they are less likely to develop confidence in their own military preparedness or receive social support in the form of unit cohesion."

Although women are well-trained for combat and other aspects of military deployment, the authors noted, "training regimens may nevertheless fail to adequately address physiological differences between men and women, leaving women feeling less prepared for deployment to combat zones."

 

 

 

 

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