A system worth saving, 2010 edition

The American Legion delivered its annual System Worth Saving Task Force Report to Congress this week, compiled from field reports by a Legion task force that evaluated VA medical centers (VAMCs) across the country.

The task force conducted two-day visits at 32 VA facilities this year, focusing on health care for women veterans, mental health care and timely budget appropriations. American Legion national staff members interviewed senior leadership and staff, inpatients in hospitals, outpatients at clinics and family members of those receiving VA health care.

“We don’t conduct these site visits just to find out what problems may exist at a particular VA facility,” said Barry Searle, director of the Legion’s Veterans Affairs and Rehabilitation Division. “We also have extensive discussion with staff and patients in figuring out ways to make improvements for the entire VA health-care system,”

Peter Gaytan, executive director of the Legion’s Washington office, said the System Worth Saving program began in 2003 and was designed, “to make certain that VA’s health-care services and programs are implemented at the local level as intended. We are well aware of all the hard work that Congress and VA put in to ensure that our veterans get access to high-quality health care. But it is also important for us to evaluate how well that effort is being carried out at individual VA medical facilities.”

Following are highlights from the 113-page document’s executive report, written by Michael D. Helm, chairman of The American Legion Veterans Affairs & Rehabilitation Commission:

One challenge the (VA) facilities faced was not receiving the fiscal year 2010 budget in a timely manner. According to the finance officer at the Miami VAMC, during March 2010, the facility had not yet received their FY 2010 appropriations. Additionally, none of the medical centers have received confirmation about their FY 2011 budgets.

Other challenges faced by all facilities visited include lack of facility clinical space for veterans and administrative space for staff, insufficient parking spaces, lack of competitive salaries for recruiting and retention of highly skilled and in-demand medical professionals. The issue of retention has been found to be a problem particularly in the maintenance of trained personnel, which has led to violations of cleaning protocols at several facilities.

However, veterans queried by the (American Legion) national field service representatives and task force members during all the SWS site visits were content with their level of care and treatment at VA.

All the facilities have been affected by increases in enrollment and workload due to the Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) conflicts and the economy. Veterans are having financial difficulties and are seeking treatment within the VA health-care system. The VA expects to treat over 439,000 OEF/OIF veterans during FY 2011.

“The American Legion is concerned that VHA’s (Veterans Health Administration) priority of giving hiring preference to veterans is not being adhered to by all VAMCs. Within the 32 VAMCs visited, approximately 25 percent of the employees are veterans. In contrast, the National Cemetery Administration reported over a 70 percent rate of veterans on staff, including a mandate that every VA cemetery hire five OEF/OIF veterans per year. Local interpretation and directives vary amongst VAMCs, as some facilities reported high numbers of veterans hired while some ratios were lower.

VA continues to address the issue of rural health care by opening new CBOCs (community-based outpatient clinics) in more rural areas. Clearly, veterans in rural and highly rural areas continue to be underserved…. It can be said, however, that veterans receiving their health care at these facilities expressed their content with the community feel of the CBOCs. Also, the clinics have helped to reduce the cost of beneficiary travel claims within the VA health-care system because veterans can now receive treatment locally.

A common theme throughout the visit cycle was the requirement for additional funding for geriatric care units. It was explained that this increase in funding is necessary because comprehensive care for mental-health geriatric patients has become a major health care-related issue within the VA health-care system.

Long-term care amongst the VAMCs has been increasing steadily over the past three year, yet there appears to be a freeze on beds available versus beds authorized. The American Legion believes this bed availability is directly tied to employment issues and hiring practices, not veteran needs or requirements.

“Progress is being made to change VA health care for a male-centric to a gender-neutral option. However, in some cases due to VA’s lack of gender-specific treatment options, women veterans are experiencing defragmented care. They are forced to seek both VA and private health care to address their unique issues. This cannot be deemed a successful transition from active duty to veteran status.

VA continues to address the need for more continuity of care for women veterans. Each VAMC was mandated to hire a women veterans coordinator, and all of the facilities we visited had adhered to this mandate. Only two of the thirty-two facilities had a stand-alone women’s clinic; however, they all provided a clinical space where women veterans could receive gender-specific care.

The American Legion is very active in volunteering regularly scheduled and occasional hours, as well as donations. The main challenges of this program are streamlining the hiring process and recruitment of younger volunteers…. Despite the difficulties in recruiting new volunteers and improving total hours for the VAVS program amongst all participating organizations, The American Legion had 202 new volunteers and a 7,118 hours increase in FY 2009. In total, The American Legion had 6,307 members that volunteered 916,598 hours in FY 2009, a total cost savings of $18.4 million to VA.

(SWS) is an ongoing effort; throughout the task force visits, we found that even with some of the issues outlined, VA’s health-care system is staffed by dedicated individuals, who are working hard to care for the nation’s veterans and to provide "the Best Care Anywhere."

The entire SWS 2010 Task Force Report should be available by the end of October on The American Legion Web site.