Veterans Have New Place to Call Home

Abstract

LOUISVILLE, KY – A novel concept in nursing home-level care – medical foster care – is providing a viable alternative for veterans who meet the requirements for nursing home care but who prefer to live in a more home-like setting. “Medical foster care provides an alternative site of care to meet the increasing demand for long-term care services,” according to June Leland, MD, medical director of the Department of Veterans Affairs Home Based Primary Care (HBPC) Program in Tampa, FL, which provides oversight of the foster care program. The program also provides longitudinal medical care to veterans enrolled in the program. Dr. Leland described the program in a poster presented at the AMDA 2015 Annual Conference. Medical foster homes offer a community-based living arrangement for veterans in need of room and board, but who require round-the-clock supervision for safety and personal care due to physical or mental impairments or disabilities, she explained in an interview. The VA serves many such veterans who prefer home-based care to nursing home care, she said. VA HBPC teams coordinate the placements in private homes with specially trained caregivers. Care is taken to ensure that placements are well-matched, taking into consideration the veteran’s health care needs and the caregiver’s skills and training. Caregivers provide a range of services, including ventilator support, mental health care for the seriously mentally ill, care for those with spinal cord injuries, and care for the frail elderly. Care may include end-of-life care and preventative care, and it can be personalized and customized for those in need who might otherwise live alone with inadequate support, Dr. Leland said. He noted that caregivers often are individuals who have previously cared for a spouse or family member and who have developed the unique skills necessary for providing quality care. The relationships between the caregivers and residents range from skilled nurse to surrogate family member, depending on the resident’s needs and desires, she said. Medical foster care also is cost-effective. The program has been shown to reduce hospitalizations and emergency room visits, and it is self-sustaining through avoidance of the high costs associated with care in LTC facilities, which total about $100 per day to taxpayers for the care of veterans, she said. In Tampa, the average fee paid by medical foster home residents is $2,292 per month – $214 per day lower than the average cost of nursing home care – resulting in a savings of $78,110 annually. Additional savings are seen due to the earlier hospital discharges, shorter lengths of stay, and decreased admissions, Dr. Leland said. Since its inception in 2000, the medical foster care program has grown from a single site to more than 45 sites across the country with a total of 561 caregivers. The average length of stay in foster care is 315 days, and the total cost savings in fiscal year 2013 was $31 million over projected costs of nursing home care, assuming all foster care residents were eligible for VA payment of nursing home care, she said. The medical foster care program is proving extremely successful and rewarding for both residents and caregivers, she said, and it continues to grow. “These are really good and kind people,” she said of the caregivers, who she said seem to find great purpose in caring for these veterans in need.