VA health care evolving

LIHU’E — Veterans Affairs services on the island of Kaua’i will be increasing the emphasis on in-home and community-based health care programs, as opposed to building nursing homes or new facilities.

That was one of the messages from a hearing of the U.S. Senate Committee on Veterans Affairs that convened in Lihu’e Monday morning. The hearing was the first of four planned throughout the state over the coming week.

After Chairman Larry Craig, R-Idaho, gaveled the session to order shortly after 10 a.m., discussion immediately launched into the state of Veterans Affairs in Hawai’i, and specifically on Kaua’i.

U.S. Sen. Daniel Akaka, D-Hawai’i, is the ranking member of the committee and was present to keep the discussion focused on Hawai’i.

Long-term health care for veterans on Kaua’i may have a very different face than elsewhere in the country and state, as funding for programs begins to shift from being “biased” toward facilities and institutions, to alternative methods of providing long-term care.

“There may be a need to adjust resources in appropriate ways and not lock them up in structures but appropriate them to alternative methods of health care,” said Craig.

Historically, health care funds have flowed more easily toward institutions or structures, Craig said, and that has to change.

“There is an old bias that health care cannot be provided adequately outside of the institutional setting,” he said.

Exploring alternatives to providing long-term health care outside the institutional setting may be one of the ways to adequately take advantage of available funding in the future, said Akaka.

“We need to start exploring alternative ways of doing long-term health care for veterans that don’t necessarily require facilities,” Akaka said. “We need to figure out the best way of providing these services best to veterans on Kaua’i.”

Some of those alternatives include utilizing “telehealth technologies” that allow satellite advisement or treatment from doctors who may be hundreds or thousands of miles away.

“One of the novel developments the VA is using to extend care is telehealth,” said Jonathan Perlin, undersecretary for the VA Health Department. “Teleconferencing is being used, with some of the devices already in veterans’ homes.”

Inhome care programs — including home hospice, home respite, home-based primary care and homemaker/home health aid — are on the rise in the state.

“Currently on Kaua’i, the VA is contracting for home health care services,” said VA Network Director Robert Wiebe. “But we’re looking at establishing a relatively modest home health care program on the island.”

To that end, Perlin said, the VA is currently recruiting for a full-time home health care position on Kaua’i.

James Hastings, director of the VA Pacific Islands Health Care System, said the position will be filled by a nurse who has special skills for doing in-home care for veterans who have problems that keep them from getting to the clinic.

As soon as the position is filled, said Hastings, the VA will go to work providing some of the services that it now contracts out.

One of the hopes of shifting the emphasis to home health care will be to combat the crowding at the community-based outpatient clinic (CBOC) in Lihu’e.

“We are approaching a tight situation in that clinic and we may not be able to create more efficiencies to make it any better,” Hastings said.

The CBOC in Lihu’e serves a veteran population of 5,420. The facility has nine full-time health care specialists including primary care doctors, a psychiatrist and nurse practitioner. At any given time the clinic can have visiting specialists from Honolulu or California.

One of the unique circumstances for this state that causes concern is veteran travel for specialty treatment.

“If a sick or disabled veteran has to travel to the Mainland for treatment, he goes alone to a place he does not know without friends or family,” said retired U.S. Navy Capt. Lynn Aylward-Bingman. “When he travels back, it is without post-op care or the surgeon who performed it.”

Another concern about specialty treatment on Kaua’i is the availability of the specialists.

“A veteran can wait months for an appointment with a specialist who comes over for one day a month,” said Aylward-Bingman.

Immediate solutions for travel and availability of specialty doctors may not be forthcoming soon. As Aylward-Bingman put it, “You are limited in care by limited funding.”

Long-term care facilities are a necessary component of the VA’s mission, even though alternatives to facilities are being explored.

Hilo, on the Big Island, will have a 95-bed facility opening in spring 2007 for veterans. On Oahu, there is a 60-bed nursing home for veterans. But here on Kaua’i, Akaka said, “there are no plans to construct a long-term facility.”

Alternatives to nursing homes on the island is another issue the VA is grappling with in its effort to offer care to veterans.

“I know my family will not be able to take care of me once I get to a certain age,” said Johnny Rabasa of Hanama’ulu, who spent 30 years active in the Army which included one tour in Vietnam.

Rabasa said he would hate to burden his family in his later years and would be willing to travel to a nursing home on another island as a last resort. “I know a facility will never come to this island,” Rabasa said.

One alternative to a nursing home may be a program adopted in Sitka, Alaska, called “Pioneer Homes.”

“Similar to Alaska, Hawaii’s dispersed veteran population on the smaller islands generally cannot justify construction of veterans’ homes on each island,” said National Association of State Veterans Homes representative Robert Shaw.

The alternative used in Alaska is a series of smaller homes, with 10 to 30 beds each, built in smaller communities. “If you could base something like that here on this island, that would be perfect,” said Kaua’i Veterans Council President Frank Cruz.

“The Pioneer Homes concept would work well here,” Aylward-Bingman said. “A series of smaller homes throughout the island.”

Edward Kawamura, member of the Veterans Advisory Council on Kaua’i, feels the program may be more culturally sensitive and would virtually allow the elderly to stay with their family.

Some other issues that need addressing, said Kawamura, include more manpower as the flow home of veterans from the Iraq and Afghanistan wars rise; more space for the CBOC; and increased funding.

Cruz feels increased staffing at the CBOC is paramount.

Akaka feels one of the biggest issues in the coming years is going to be returning veterans from Iraq and Afghanistan.

“For me there is no question we have to address that. Many of the vets will be returning with PTSD (post traumatic stress disorder),” Akaka said, “And we have to be ready.”

The last hearing on Friday in Hilo will address that subject.

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