NADSA and Veterans Administration Share Updates on Respective Programs

Sara Myers, NADSA Managing Director

Adult day services was the topic of focus for a June meeting in Chicago. Representatives from the National Adult Day Services Association, Easter Seals, the Arizona Adult Day Services Association, the Minnesota Adult Day Services Association and the Texas Adult Day Services Association met with Veterans Administration representatives Dr. Thomas Edes and Rick Greene.

NADSA continues to anxiously await passage of an updated manual designed to foster and encourage VA regional staff to develop contracting and referral relationships with local adult day centers. The effort began almost two years ago with representatives from the VA (Rick Greene), Easter Seals (Jed Johnson), and NADSA (Merle Griff). The manual was completed but has yet to be "signed" and distributed.  Dr. Edes agreed to check into the process and Rick Greene assured meeting participants that the manual would soon be released.

The manual will go a long way to bringing continuity in how the VA develops and contracts with adult day service providers across the country.  Immediate concerns were raised about some veterans being dropped from service or dramatically restricted in their access to adult day services.  On the other hand, not all states are experiencing inconsistencies, and recognition was made for new contracts being issued, although referrals were not being made. There was consensus that payment from the VA was very, very slow—causing operational difficulties.

Dr. Edes was not sure why there is so much inconsistency and agreed to put the issue on the agenda for conference calls regularly held with regional VA representatives. Dr. Edes explained that a medical benefits package is available to all veterans if there is a demonstrated need and unless the service is a nursing home, the disability does not have to be service-connected. Co-pays are required by law.

Dr. Edes suggested that adult day centers invite their local VA representative to their centers and try and develop relationship around training and education.

NADSA Managing Director Sara Myers gave a presentation on meeting the needs of those living with traumatic brain injuries (TBI) by using the resources of adult day health (ADH). Those with a TBI will probably not be eligible for adult day health through the VA, but the skilled care resources could nonetheless be used to provide Resource Coordination services, a kind of short-term counseling. Currently in Washington state, four ADH centers offer Resource Coordination Services to those living with TBI. The contract with the state was renewed through June 2010.

Lisa Peters-Buemer reported on the Easter Seals project, "Bridging Hospice and Adult Day Services to Provide End of Life and Palliative Care."  Lisa talked about the need to offer better end-of-life care, in general, and the possibility that adult day centers can facilitate that. The project operates on multiple levels: policy, center self-evaluation, and training. Beth offered her own experience and said that she had been certain that her center was doing a good job with end of life issues until staff at the center used the self-evaluation tool and took the training from Easter Seals. As a result of the Easter Seals end-of-life project, her adult day center has improved its performance. 

Rick Greene reported on the National Rural Health Initiative grant that the VA received. Over $26 million has been allocated to the VA to work with the VA Primary Care Program to help meet needs of veterans in rural areas.  In the process, the VA attempted to get information to the VA medical centers to think about innovative ways to partner with Indian Tribe Health Care in rural areas and with adult day center to "house" primary care. Unfortunately, the turnaround time was too short for VA centers to develop new agreements with day centers.

NADSA and the VA will continue dialogue about other collaborations that will benefit veterans through adult day health services.