diabetes Home-based Primary Care Program

[Sam]

My husband is 100% SC and has been enrolled in the home base primary care since 2003.In the beginning the nurse came to the house every 30 days and the doctor visited when needed. But for the past years 2006/2007 the visits have dropped off the nurse come maybe every 60 plus days and the doctor hasn't visited in about 2 years. I have been told that his nurse now has 40 vets to see and the doctor is swamped with other duties. The 50 mile limit is no longer in affect for the plan and she must see all her patients, plus my husband every 30 days. My husband has to use a wheelchair to visit some of the specialist doctor than are not in the program and it takes about a day for him to recover from the trip. I received a call from his nurse asking me to change to another in clinic primary care doctor who is not in the program. The reason is his primary doctor who is in the program cannot meet his needs. This all happened after another doctor who was reviewing his file discovered that his high blood pressure wasn't being treated. I had been asking for a year about this issue. He has seizures,dementia,diabetes,high blood pressure and constant leg pain.

He was declared incompetent and I am his assigned caretaker. It appears they want my husband out of the program to make place for someone else. Can someone provide some advise on what I should do.

Thanks: Dedicated Wife

[Berta]

I dont know how this type of program works but this concerns me:

"This all happened after another doctor who was reviewing his file discovered that his high blood pressure wasn't being treated. I had been asking for a year about this issue"

If these are VA doctors-looks to me they might have feared

some charges against them-

Have they actually changed his HBP meds to the proper dosage since discovering this medical error?It is negligence unless they correct a medical error before any damage has been done.

Improper HBP medication that is not monitored well can lead to transcient ischemia, CVA, CAD, and dementia.

I wonder if this medical error caused any of the conditions he has- it sure didnt help them.

The wrong dose of HBP meds was found by the VA to have contributed to my husband's death.

When was his last rating done for all of these conditions?

I am even wondering when the last MRI and EKG was done on him.

Edited February 3, 2008 by Berta

[Berta]

All I have is this info from the AL and the link dated 2005:

You said he gets 100% comp-Doesn't he get Aid and Attendance Benefits too?

"VA HBPC: VA Home-Based Primary Care (HBPC) is a home care program that provides comprehensive, interdisciplinary, primary care in the homes of veterans with complex medical, social, and behavioral conditions for whom routine clinic-based care is not effective. In contrast to other systems such as Medicare home care (which targets patients with short-term remediable needs and provides episodic, time-limited and focused skilled services) HBPC targets patients with complex, chronic, progressive disabling disease and provides comprehensive longitudinal home care. HBPC is designed to serve the chronically ill through the months and years before death, providing primary care, palliative care, rehabilitation, disease management and coordination of care services. HBPC targets primarily three types of patients in need of home care:

(a) Longitudinal care patients with chronic complex medical, social, and behavioral conditions.

( Longitudinal care patients who require palliative care for an advanced disease that is life limiting or refractory to disease modifying treatment.

© Patients whose home care needs are expected to be of short duration or for a single problem not requiring an interdisciplinary team, when such services best help the facility meet the needs of this population.

The goals of care for HBPC patients are to:

. Promote the veteran's maximum level of health and independence by maintaining optimal physical, cognitive and psychosocial functioning.

. Reduce the need for, and provide an acceptable alternative to, hospitalization, nursing home care, emergency room and outpatient clinic visits, through close monitoring and a creating a therapeutic and safe environment in the home.

. Assist in the transition from a health care facility to home by providing patient/caregiver education, guiding rehabilitation and use of adaptive equipment in the home, adapting the home as needed for a safe and therapeutic environment, and arranging and coordinating supportive services.

. Enhance quality of life through symptom management and other palliative care measures.

. Meet the changing needs and preferences of the veteran and family.

. Support the caregiver in the care of the veteran.

. Provide comfort by managing pain and other symptoms.

HBPC has demonstrated its ability to substantially reduce hospitalizations, hospital bed days of care and total cost of care. Medicare home care has not been demonstrated to achieve any of these outcomes. At www.va.gov/sta/guide/division.asp you can determine the locations & phone numbers of all VA medical centers. Contact the one nearest you and request to speak with a Social Worker for assistance if you are interested in this VHA program. [source: VA Web site www1.va.gov/geriatricsshg/docs/HBPCDef.doc Oct 05]"

[Sam]

Thanks for the information this is the same information that was given to me. He is receiving A@A that is how he got into the HBPC program. The doctor that didn't put him on medicine was the primary care doctor assigned to him in the HBPC program. He is supposed to call and schedule a in home visit? The doctor that is following him on the blood pressure has adjusted his medicine but doesn't understand why the other doctor didn't get involved. I called the VFW rep and he gave me a number of a director at the hospital in Dallas. I am going to call him tomorrow. My husband has received great care from the nurses and other people in the program, the doctor is a very good but they have him doing so many other things outside the program that he doesn't have time to properly address my husbands issues. I think they are trying to push out the older veterans to make place for the new incoming vets. His last MRI was last year he hasn't had a EKG since 2002. I was hoping to get input from other veterans on this program that may experiencing the same issues?

Thanks: Dedicated Wife

[Pete53]

Sam:

I think that you are being forced to change and that the care he is getting is not good care at all. I suggest that you meet with a Social Worker to see what all the options are. Does he have Medicare it seems that the VA is forcing Veterans to use Medicare if they have it.

I will see if I can find out anything. I think that you should also look into getting a Health Buddy for your husband at least you will have better contact with the VA.

Good Luck

[dansdad]

pete53,the info that 'wings'posted concerning the new bill.has several sections that might help in this problem they fall in subtitle C Health care matters sec.#1631,1632,and 1633. 1633 discusses "RESPITE CARE "this is just what the doctor ordered.I hope we can see the verbage soon ,its an idea a little outside the box,but an idea anyway.good luck sam im puting you on my prayer list NOW..

[Sam]

Just got off the phone with a member of the Directors Staff Dallas Hospital. He stated quote per a directive from Secretary Of VA "Iraq Vets" will be seen first. I object to this statement and told him they should handle the problem in a different manner like add staff to the program. But pushing older vets out was not handling the problem I am mad as hell. He stated he was a Vietnam Vet like my husband "brothers" and couldn't believe the statement himself but assured me my husband would not be pushed out. I don't want to hold my breath on that statement. To answer some of the other questions my husband has had a Health Buddy for 2 years and all the information is documented in his health records. Due to his health problems he would need a nurse assigned to him and Social Security won't pay unless he is on his death bed. I have to handle this issue because my husband health comes first he gets upset when people do him wrong and doesn't pick his words wisely since he got sick. He has seizures and when he gets upset he usually has them. I am going to start contacting other people to let them know what is going on in the system.

Thanks Mary