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VHA Directive 1140.11, Uniform Geriatrics and Extended Care

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VHA Directive 1140.11, Uniform Geriatrics and Extended Care Department of Veterans Affairs VHA DIRECTIVE 1140.11 Veterans Health Administration Transmittal Sheet Washington, DC 20420 October 11, 2016 UNIFORM GERIATRICS AND EXTENDED CARE SERVICES IN VA MEDICAL CENTERS AND CLINICS 1. REASON FOR ISSUE: This Veterans Health Administration (VHA) directive defines minimum clinical requirements for VHA Geriatrics and Extended Care (GEC) Services. The inclusion in 38 CFR 17.38 - Medical benefits package (hereinafter the VA Medical Benefits Package) of home health services authorized under Title 38 United States Code (U.S.C.) 1717 and 1720C, hospice care, palliative care, institutional respite care, and noninstitutional extended care services (including but not limited to noninstitutional geriatric evaluation, noninstitutional adult day health care, and noninstitutional respite care) that Department of Veterans Affairs (VA) furnishes on an outpatient basis as alternatives to institutional extended care (nursing home care) reflects a Congressional intent that all enrolled Veterans have access to these GEC services. This directive provides a rationale and description for each GEC program component to be implemented nationally, ensuring that VA medical centers’ GEC programs are suitably organized, staffed, and integrated with other services, particularly Patient-Aligned Care Teams (PACT) and are Veteran-centric. This directive clarifies these services’ integration within the VHA GEC continuum of care for all ages of Veterans including seriously injured Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) Veterans. It also outlines caregiver support services essential to maintain high-risk Veterans in the least-restrictive environment, because families/caregivers (traditional and non-traditional) are essential partners in the care of Veterans needing assistance with daily care (people with disabilities and/or frail older adults). 2. SUMMARY OF MAJOR CHANGES: This revised VHA policy updates VHA Handbook 1140.11, dated November 4, 2015, by correcting the programs that are subject to copayment and updating the list of programs that need to be available to Veterans in accordance with the medical benefits package. 3. RELATED ISSUES: VHA Handbook 1140.01, VHA Handbook 1140.02, VHA Handbook 1140.3, VHA Handbook 1140.04, VHA Handbook 1140.5, VHA Handbook 1140.6, VHA Handbook 1140.07, VHA Handbook 1140.08, VHA Handbook 1140.09, VHA Handbook 1140.10, VHA Handbook 1140.02, VHA Handbook 1140.3, VHA Handbook 1141.01, VHA Handbook 1141.02, VHA Handbook 1141.03, VHA Handbook 1142.02, VHA Handbook 1145.01, VHA Handbook 1160.01, VHA Handbook 1173.14, VHA Handbook 1173.17, VHA Handbook 1176.01. 4. RESPONSIBLE OFFICE: The Office of Patient Care Services, Office of Geriatrics and Extended Care (10P4G) is responsible for the contents of this VHA directive. Questions may be referred to 202-461-6770. 5. RESCISSION: VHA Handbook 1140.11, dated November 4, 2015, is rescinded. T-1 October 11, 2016 VHA DIRECTIVE 1140.11 6. RECERTIFICATION: This VHA directive is scheduled for recertification on or before the last working day of October, 2021. This VHA directive will continue to serve as national VHA policy until it is recertified or rescinded. David J. Shulkin, M.D. Under Secretary for Health DISTRIBUTION: Emailed to the VHA Publications Distribution List on October 13, 2016. T-2 October 11, 2016 VHA DIRECTIVE 1140.11 CONTENTS UNIFORM GERIATRICS AND EXTENDED CARE SERVICES IN VA MEDICAL CENTERS AND CLINICS 1. PURPOSE .............................................................................................................. 1 2. BACKGROUND ...................................................................................................... 1 3. DEFINITIONS ......................................................................................................... 3 4. POLICY ................................................................................................................... 4 5. REQUIREMENTS ................................................................................................... 4 6. IMPLEMENTATION ................................................................................................ 7 7. STRUCTURE AND GOVERNANCE OF GEC SERVICES ..................................... 8 8. RESPONSIBILITIES ............................................................................................... 9 9. GERIATRIC WORKFORCE ADEQUACY ............................................................. 10 10. STAFF DEVELOPMENT AND EDUCATION ...................................................... 11 11. PREVENTIVE CARE .......................................................................................... 11 12. GERIATRIC EVALUATION ................................................................................. 13 13. GERIATRIC CLINICS AND CONSULTATION SERVICES ................................. 14 14. NON-INSTITUTIONAL EXTENDED CARE ......................................................... 17 15. INSTITUTIONAL EXTENDED CARE .................................................................. 21 16. HOSPICE AND PALLIATIVE CARE ................................................................... 24 17. ELDERLY INPATIENTS ...................................................................................... 26 18. DEMENTIA PROGRAMS .................................................................................... 28 19. NEW DEVELOPMENTS IN GEC PROGRAMS .................................................. 31 20. GERIATRIC RESEARCH, EDUCATION, AND CLINICAL CENTERS ................ 32 21. EMERGENCY AND DISASTER PREPAREDNESS ........................................... 33 22. RURAL ACCESS TO GEC SERVICES .............................................................. 35 23. NATIVE AMERICAN VETERANS OF ADVANCED AGE.................................... 36 24. WOMEN VETERANS OF ADVANCED AGE ...................................................... 37 25. VETERANS WITH SPINAL CORD INJURY AND DISORDERS ......................... 38 26. VETERANS REQUIRING MECHANICAL VENTILATION ................................... 39 27. CARE TRANSITIONS ......................................................................................... 39 28. CARE MANAGEMENT ....................................................................................... 40 i October 11, 2016 VHA DIRECTIVE 1140.11 29. CAREGIVER SUPPORT ..................................................................................... 42 30. TRANSPORTATION BARRIERS ........................................................................ 44 31. COMMUNITY PARTNERSHIPS ......................................................................... 45 32. INTEGRATING GEC AND PRIMARY CARE SERVICES ................................... 46 33. INTEGRATING GEC SERVICES AND REHABILITATION PROGRAMS ........... 48 34. INTEGRATING GEC AND MENTAL HEALTH SERVICES ................................. 49 35. INTEGRATING GEC AND SURGICAL/SPECIALTY CARE PROGRAMS.......... 51 36. INTEGRATING GEC AND DENTAL SERVICES ................................................ 51 37. INTEGRATING GEC WITH ACADEMIC AFFILIATIONS .................................... 52 38. GEC INFORMATICS, WORKLOAD CAPTURE .................................................. 53 39. PERFORMANCE AND QUALITY IMPROVEMENT ............................................ 54 40. REFERENCES ................................................................................................... 56 ii October 11, 2016 VHA DIRECTIVE 1140.11 UNIFORM GERIATRICS AND EXTENDED CARE SERVICES IN VA MEDICAL CENTERS AND CLINICS 1. PURPOSE This Veterans Health Administration (VHA) directive defines minimum clinical requirements for VHA Geriatrics and Extended Care (GEC) Services. The inclusion in the Department of Veterans Affairs (VA) Medical Benefits Package of home health services authorized under Title 38 United States Code (U.S.C.) 1717 and 1720C, hospice care, palliative care, institutional respite care, and noninstitutional extended care services (including but not limited to noninstitutional geriatric evaluation, noninstitutional adult day health care, and noninstitutional respite care) that VA furnishes on an outpatient basis as alternatives to institutional extended care (nursing home care) reflects a Congressional intent that all enrolled Veterans have access to these GEC services. This directive provides a rationale and description for each GEC program component to be implemented nationally, ensuring that VA medical facilities’ GEC programs are suitably organized, staffed, and integrated with other services, particularly Patient-Aligned Care Teams (PACT). This directive clarifies these services’ integration within the VHA GEC continuum of care for all ages of Veterans including seriously injured OEF/OIF/OND Veterans. It also outlines caregiver support services essential to maintain high-risk Veterans in the least-restrictive environment because families/caregivers (traditional and non-traditional) are essential partners in the care of Veterans needing assistance with daily care (people with disabilities and/or frail older adults). AUTHORITY: 38 U.S.C. 1717, 1720C and 38 CFR 17.38. 2. BACKGROUND a. VHA’s current approach to Geriatrics and Extended Care Services can be traced to various discrete processes and events unfolding over the past 80 years: VHA’s development of nursing home practices; VHA’s adoption of geriatric assessment (matching Veteran needs and expectations of functionality and independence to the services provided);
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