A Real Solution

Reprinted from PN/Paraplegia News September 2014

Since April’s revelations of access problems within the Department of Veterans Affairs (VA) health care system, many have rushed to pronounce a solution: Overhaul leadership, hire more staff, reduce the size of the system or eliminate the system completely and establish a model similar to Medicare, among others.

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Lots of ideas, but only one will truly identify all the problems and lead to meaningful change: Work directly with veterans and their representatives. Finally, the VA has recognized this.

In July, VA Under Secretary for Health Carolyn Clancy, MD, reached out to Paralyzed Veterans of America (PVA) and arranged monthly meetings to discuss the findings of our site visits.

We’re pleased to be part of the solution, as no one recognizes the need to preserve the VA system more than veterans with spinal-cord injury (SCI).

We recognize also that VA health care is the only option for the thousands of other veterans requiring specialized services, including those with traumatic brain injury, major limb amputations and those who are visually impaired or blind. For these veterans, appropriate care outside the VA is limited by geography and the absence of a continuum that mirrors the VA’s comprehensive system of care.

The U.S. has 14 non-VA Model Systems of Care for SCI that employ psychiatrists, therapists and nurses who offer general rehabilitation, sports medicine, pain management and treatment for strokes, orthopaedic injuries and SCI.

No non-VA system offers the continuum of care from initial disability to end of life. This holistic, veteran-centric environment is crucial to the care of the most catastrophically injured and cannot be replicated.

PVA has a long history of working with the VA to improve the system. We work more closely with the VA than any other veterans service organization. Our medical staff, service officers and leadership who visit VA facilities nationwide examine every possible aspect of care.

The site visit team consists of a registered nurse, a physician, an architect, a service officer, a member of the Field Advisory Committee and the hospital liaison officer.

Over three to four days, the team meets with members of the local chapter to gather the patient’s perspective. Meetings are held with the hospital director and the heads of all the clinical and administrative departments for extensive discussions with various clinical departments, as well as prosthetics and facilities management.

During this time, the team also inspects the facilities and meets with all the SCI veterans admitted there. Findings are reported to the hospital administrators and department heads at an exit briefing. After the site visit, a formal report of findings is prepared and submitted to the hospital director and the Secretary of Veterans Affairs.

The PVA site visit provides a great deal of valuable information regarding the quality of the operations and medical care provided by VA SCI centers.

It uncovers any long waits for hospital admissions or appointments and whether necessary surgery or procedures are being delayed or denied. The team determines if staffing levels are adequate to provide good care. SCI centers’ conditions and cleanliness are also determined and reported.

And, critically important, SCI centers’ institutional culture is revealed. Is it an institution that takes pride in providing quality and compassionate care to the SCI veterans or is it just going through the motions?

In all probability, had site visits like the ones PVA conducts for the SCI centers been made to the rest of the VA Healthcare System, their current problems would not exist.

While the VA has taken a great first step by reaching out to PVA and initiating these monthly meetings where we can discuss in great detail our site visit findings, we recognize that correcting the many problems within the system is going to take time.

We encourage the VA to seek input from other veterans service organizations as well to ensure all perspectives and experiences are considered.

I also encourage you to voice your concerns, share your insights and even offer suggestions to your VA caregivers.

The key to any real solution begins and ends with those who receive care at the VA.


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