- Contact the Committee

STATEMENT OF

THOMAS H. MILLER, EXECUTIVE DIRECTOR

BLINDED VETERANS ASSOCIATION

BEFORE THE

SUBCOMMITTEE ON HEALTH

COMMITTEE ON VETERANS’ AFFAIRS

U.S. HOUSE OF REPRESENTATIVES

ON

DEPARTMENT OF VETERANS AFFAIRS LONG-TERM CARE PROGRAMS 

May 22, 2003 

Chairman Simmons, Ranking Member Rodriguez, and members of this Subcommittee, thank you for this opportunity to present the views of the Blinded Veterans Association regarding Department of Veterans Affairs (VA) long-term care programs.  BVA feels there are many parallels in VA’s attitudes toward long-term care and blind rehabilitation.  There is a need for a fully operational continuum of care in both services.  The need for both long-term care and blind rehabilitation is projected to increase in the coming years as the veteran population rapidly increases. 

The Millennium Health Care Act directs the Secretary of Veterans Affairs to increase and expand VA’s ability to provide long-term care to its aging veteran population. The Secretary’s proposal to close 5,000 long-term beds concerns BVA.  VA claims that the money saved by closing these beds will be used to provide non-institutional alternatives as well as state and community nursing home beds.  As often happens with VA, the numbers do not add up; the money “saved” from closing the VA nursing home beds is not equal to the money set aside for these non-VA alternatives.  BVA has a hard time understanding why, in this time of an aging population, any type of long-term care options would be diminished.  We agree that non-institutional and local opportunities need to be explored and supported, but also strongly encourage VA to maintain the capacity, as the law requires, of VA nursing home beds.  Not everyone desires or is able to receive home health care. 

Congress, and this Committee in particular, need to hold VA for accountable for its failure to maintain capacity.  As with other laws setting capacity requirements, such as PL 104-262, VA continues to enjoy liberal interpretation and little, if any accountability, for repeatedly failing to meet Congressionally mandated standards.     

BVA is extremely disturbed that VA fails to address long-term care in Phase II of the Capital Asset Realignment for Enhanced Services (CARES).  Projections for the need for long-term care were estimated, but the numbers were too high, it was decided that this issue would not be addressed.  According to the General Accounting Office report “Department of Veterans Affairs: Key Management Challenges in Health and Disability Programs" (GAO-03-756T) when asked about the omission of long-term care from the CARES process, VA said that “the projections did not reflect its long-term care policy.”1  The projections did not reflect their budget either.

BVA would be remiss in not taking this opportunity to discuss the need for expanding the continuum of care of blind rehabilitation services as preventing, or at least delaying, the need for long-term care.  Currently, VA offers comprehensive blind rehabilitation only in a residential setting.  Over 2,600 blinded veterans are awaiting entrances into one of the 10 Blind Rehabilitation Centers (BRCs) across the country.  Many wait up to year.  Very few of the 92 Visual Impairment Service Team (VIST) Coordinators, essentially case managers for blinded veterans, are allowed to contract locally for much needed services.

If a veteran cannot or will not travel away from home for blind rehabilitation, they are out of luck.  Comprehensive blind rehabilitation allows blinded veterans to live a more independent life.  BVA is concerned about the physical and mental health of those blinded veterans who cannot or will not attend a BRC.  These veterans are more likely to injure themselves or others, and are more dependent on a caregiver.  If a blinded veteran’s caregiver dies or is no longer able to assist him or her, long-term care will most often be the only option.  This does not have to be the case.   

VA is known worldwide for excellence in its comprehensive blind rehabilitation services.  A veteran receives adaptive skills to maximize independent function in activities of daily living such as cooking, financial management, and communication and medication management.  The skills taught also include orientation and mobility instruction, comprehensive low vision evaluation (including prescription of and training with low vision aids and devices), psychosocial adjustment counseling, and the option of computer access training.  Blinded veterans who attend a BRC develop more wholesome and healthier attitudes about blindness and achieve more successful reintegration into their families and communities.  

As the veteran population ages, it is becoming increasingly more difficult for those veterans who desire blind rehabilitation to leave their local community for a long period of time to receive much needed blind rehabilitation services.  All of these factors keep a veteran happier, healthier, and safer than if they had received no blind rehabilitation.  

Unlike the larger health care system, VA Blind Rehabilitations Service (BRS) did not embrace the transition from hospital-based rehabilitative care to outpatient care, but has steadfastly maintained the inpatient approach to the provision of blind rehabilitation services.  As a consequence of failing to develop and implement outpatient models of blind rehabilitation, many of the residential or inpatient BRCs have lost capacity because essential professional staff positions have been taken to support other outpatient priorities in their respective Networks.  

In our view, while VA struggles to achieve a more appropriate balance between tertiary and outpatient care, VA BRS must, for the first time, establish an appropriate balance between inpatient and outpatient service delivery by expanding its capacity to provide outpatient services at the local level.  This shift is imperative if the unique and special needs of an aging veteran population with severe visual impairment and blindness are to be served.  

We are all aware of the aging veteran population and the increasing need and demand for health care services associated with aging.  Mr. Chairman, aging is the single best predictor for blindness or severe visual impairment.  As the overall population of veterans ages, more and more veterans are losing their vision, requiring rehabilitative services.  Because of all the other chronic medical problems associated with aging, more and more members of our blinded veteran population are either unable or unwilling to leave home to attend a comprehensive residential BRC as this often necessitates traveling hundreds of miles to the nearest BRC.  Also preventing many of these veterans from leaving home is the change in roles within their families.  Spouses of these veterans have developed serious health problems and are often disabled themselves, relying on the veteran for their care.  Consequently, the blinded veteran who has been the recipient of care has been forced into becoming the caregiver.  

 Unfortunately, the current reimbursement model for resource allocation fails to provide incentives for facilities for the provision of local services.  With respect to the allocation model, if the local VAMC refers a veteran to the BRC, the local VAMC will not have to pay for any services delivered or the prosthetics prescribed.  Should the VAMC provide service locally, however, the VAMC must for pay for the care. 

Mr. Chairman, given access to appropriate blind rehabilitation services, no veteran need be placed into a nursing home care bed solely because of blindness; other medical complications should be the only reason for such a placement.  VA BRS needs to develop an aggressive strategic plan to address the needs of older veterans, especially those who are unable to attend the BRC program.   

Thank you very much for this opportunity to share the views of the Blinded Veterans Association regarding long-term care and specifically how it relates to blinded veterans.  We look forward to working with this Committee to ensure that all blinded veterans receive the services they need.  BVA also hopes that this Committee will assure that VA continues to expand, and not diminish, its ability to provide a wide variety of long-term care options, including VA nursing home beds.  Both VA blind rehabilitation services and long-term care are needed now more than ever to meet the needs of those who sacrificed so much for our freedom.