I got a call from the RO offering "time out" from health care duties. The director of the program explained that this program offers 30 days annual respite care for the caregiver of a chronically ill vet. Based on bed availability, a veteran even can be admitted to a VA hospital for up to 7 days (non-medical stay) while the caregiver takes a break. I had never heard of this before I was offered the benefit, so thought others might need to know.
T-1
Department of Veterans Affairs M-5, Part VII
Veterans Health Administration Chapter 1
Washington, DC 20420
March 3, 1995
FOREWORD
This manual chapter promulgates the policies and procedures for implementation of the Respite Care Programs of Deaprtment of Veterans Affairs health care facilities throughout the country.
1.07 Termination of Respite Care............................................................................
....... 1-3
Chapter 1
1-1
CHAPTER 1. RESPITE CARE
1.01 PURPOSE
a. This chapter defines the role of respite care within the Veterans Health Administration (VHA).
b. It is generally recognized that most chronically ill persons who do not need hospital services can be most effectively cared for, if, through the assistance of family or other members of the household, they are able to live at home. At the same time, there is recognition that such arrangements for care of a patient at home may place severe physical and emotional burdens on the caregiver and the household.
c. The clinical objective of providing institutionally based respite care is to support the caregiver's role in caring for the chronically ill veteran at home. A critical element of respite is planning in advance for the benefit of the caregiver, rather than being incidental to the provision of necessary medical care of the patient.
1.02 POLICY
Title 38 United States Code (U.S.C.) Section 1720B authorizes the Department of Veterans Affairs (VA) to provide institutional respite care without affecting other eligibility criteria.
1.03 DEFINITION
Respite care means medical center or nursing home care, which is:
(1) Of limited duration;
(2) Furnished in a medical facility on an intermittent basis to a veteran who is suffering from a chronic illness and who resides primarily at home; and
(3) Furnished for the purpose of helping the veteran to continue residing primarily at home.
1.04 SCOPE
a. VA medical centers may provide respite care to an eligible veteran for up to 30 days in a calendar year. Families and patients who are in need of respite care in excess of 30 days because of unforeseen difficulties, such as the unexpected death of the caregiver, may, with the approval of the medical center Director, furnish additional days of care.
b. VA medical centers are not authorized to provide respite care:
(1) In an Ambulatory Care Program;
(2) In domiciliary beds;
(3) Through contractual agreements; or
(4) In the home. NOTE: This is not intended to preclude the possible need to develop a program using
volunteers and/or community resources to provide intermittent respite in the home.
M-5, Part VII March 3, 1995
Chapter 1
1-2
c. Patients considered for admission will be admitted based on eligibility and admission priorities as outlined in M-1, Part I, Chapters 4 and 12. Beds will not be dedicated for respite care.
d. When a treatment team determines that respite care services are indicated to support the caregiver's role in caring for the chronically ill veteran at home, then the service will be provided at that medical center.
1.05 RESPONSIBILITY
a. A medical center policy will be developed by each medical center to identify how the Respite Care Program will operate and who is responsible.
b. The medical center Director has overall responsibility for the Respite Care Program. The Chief of Staff (COS), the Associate Chief of Staff (ACOS) for Geriatrics and Extended Care, or the ACOS for Ambulatory Care has programmatic responsibility.
c. A Respite Care Coordinator will be appointed by the COS, or designee, and will be accountable for the operation and management of the program.
(1) The coordinator must have demonstrated ability and competence in both patient care and/or program administration.
(2) The Respite Care Coordinator is responsible for:
a Coordinating referrals;
b Coordinating admissions; and
c Orienting the patient and caregiver to the Respite Care Program.
d. An interdisciplinary team will be responsible for screening the patient and formulating the respite care treatment plan for the patient, including frequency, duration and recommendation for patient activities while in the medical center or nursing home care unit (NHCU).
(1) The Adult Day Health Care (ADHC), Hospital Based Home Care (HBHC), Mental Health, and VA NHCU interdisciplinary teams may serve in this capacity.
(2) Otherwise, the interdisciplinary team will be composed of the physician primarily responsible for the patient's care, a nurse, and the social worker assigned the Respite Care Program responsibility.
NOTE: The treatment plan should be developed in conjunction with the primary caregiver.
e. The physician member of the patient's interdisciplinary team will be responsible for or will supervise the respite care of the patient. The physician along with the team members will ensure that there is coordination between the existing outpatient and/or home treatment plan and the respite care treatment plan.
(1) The respite care treatment plan can include the following:
Drug review,
Drug management,
Mental health intervention,
March 3, 1995 M-5, Part VII
Chapter 1
1-3
(d) Physical therapy,
(e) Occupational therapy,
(f) Corrective therapy,
(g) Recreation therapy,
(h) Speech therapy,
(i) Manual arts therapy, and
(j) Intravenous (IV) administration.
(2) The respite care treatment plan mandates there will not be any self-administered medication.
1.06 ADMISSION GUIDELINES
The following guidelines define admission criteria:
a. The patient's caregiver is in need of relief from the day to day patient care tasks.
b. The patient is suffering from a chronic illness and/or has a prolonged recuperation from surgery or an injury incurred from an accident.
c. The patient must be determined eligible for medical center or nursing home care under 38 Code of Federal Regulations (CFR) 17.47. NOTE: Eligibility criteria are published in M-1, Part I, Chapters 4 and 12.
d. Respite care, as a form of medical center or nursing home care, will follow the same priorities that are used for all hospital and nursing home care. In accordance with 38 CFR 17.49, the Under Secretary for Health has established priorities for admission to hospital and nursing home care. These priorities are published in M-1, Part I, Chapter 4.
e. Patients admitted directly from the community and not currently known to VA will have a physical assessment completed immediately.
1.07 TERMINATION OF RESPITE CARE
Termination from respite care will occur when the patient is:
a. Released to the caregiver (home), or
b. Transferred to another level of care because the:
(1) Caregiver will no longer be able to provide care to the patient;
(2) Patient becomes acutely ill; or
(3) Patient becomes terminally ill and the anticipation of death prevents discharge from hospital or nursing home care.
Question
Guest Morgan
I got a call from the RO offering "time out" from health care duties. The director of the program explained that this program offers 30 days annual respite care for the caregiver of a chronically ill vet. Based on bed availability, a veteran even can be admitted to a VA hospital for up to 7 days (non-medical stay) while the caregiver takes a break. I had never heard of this before I was offered the benefit, so thought others might need to know.
T-1
Department of Veterans Affairs M-5, Part VII
Veterans Health Administration Chapter 1
Washington, DC 20420
March 3, 1995
FOREWORD
This manual chapter promulgates the policies and procedures for implementation of the Respite Care Programs of Deaprtment of Veterans Affairs health care facilities throughout the country.
M-5, Part VII March 3, 1995
March 3, 1995 M-5, Part VII
Chapter 1
1-i
CONTENTS
CHAPTER 1. RESPITE CARE
PARAGRAPH PAGE
1.01 Purpose ................................................................................
................................1-1
1.02 Policy ................................................................................
...................................1-1
1.03 Definition ................................................................................
..............................1-1
1.04 Scope ................................................................................
...................................1-1
1.05 Responsibility ................................................................................
........................1-2
1.06 Admission Guidelines......................................................................
........................1-3
1.07 Termination of Respite Care............................................................................
....... 1-3
Chapter 1
1-1
CHAPTER 1. RESPITE CARE
1.01 PURPOSE
a. This chapter defines the role of respite care within the Veterans Health Administration (VHA).
b. It is generally recognized that most chronically ill persons who do not need hospital services can be most effectively cared for, if, through the assistance of family or other members of the household, they are able to live at home. At the same time, there is recognition that such arrangements for care of a patient at home may place severe physical and emotional burdens on the caregiver and the household.
c. The clinical objective of providing institutionally based respite care is to support the caregiver's role in caring for the chronically ill veteran at home. A critical element of respite is planning in advance for the benefit of the caregiver, rather than being incidental to the provision of necessary medical care of the patient.
1.02 POLICY
Title 38 United States Code (U.S.C.) Section 1720B authorizes the Department of Veterans Affairs (VA) to provide institutional respite care without affecting other eligibility criteria.
1.03 DEFINITION
Respite care means medical center or nursing home care, which is:
(1) Of limited duration;
(2) Furnished in a medical facility on an intermittent basis to a veteran who is suffering from a chronic illness and who resides primarily at home; and
(3) Furnished for the purpose of helping the veteran to continue residing primarily at home.
1.04 SCOPE
a. VA medical centers may provide respite care to an eligible veteran for up to 30 days in a calendar year. Families and patients who are in need of respite care in excess of 30 days because of unforeseen difficulties, such as the unexpected death of the caregiver, may, with the approval of the medical center Director, furnish additional days of care.
b. VA medical centers are not authorized to provide respite care:
(1) In an Ambulatory Care Program;
(2) In domiciliary beds;
(3) Through contractual agreements; or
(4) In the home. NOTE: This is not intended to preclude the possible need to develop a program using
volunteers and/or community resources to provide intermittent respite in the home.
M-5, Part VII March 3, 1995
Chapter 1
1-2
c. Patients considered for admission will be admitted based on eligibility and admission priorities as outlined in M-1, Part I, Chapters 4 and 12. Beds will not be dedicated for respite care.
d. When a treatment team determines that respite care services are indicated to support the caregiver's role in caring for the chronically ill veteran at home, then the service will be provided at that medical center.
1.05 RESPONSIBILITY
a. A medical center policy will be developed by each medical center to identify how the Respite Care Program will operate and who is responsible.
b. The medical center Director has overall responsibility for the Respite Care Program. The Chief of Staff (COS), the Associate Chief of Staff (ACOS) for Geriatrics and Extended Care, or the ACOS for Ambulatory Care has programmatic responsibility.
c. A Respite Care Coordinator will be appointed by the COS, or designee, and will be accountable for the operation and management of the program.
(1) The coordinator must have demonstrated ability and competence in both patient care and/or program administration.
(2) The Respite Care Coordinator is responsible for:
a Coordinating referrals;
b Coordinating admissions; and
c Orienting the patient and caregiver to the Respite Care Program.
d. An interdisciplinary team will be responsible for screening the patient and formulating the respite care treatment plan for the patient, including frequency, duration and recommendation for patient activities while in the medical center or nursing home care unit (NHCU).
(1) The Adult Day Health Care (ADHC), Hospital Based Home Care (HBHC), Mental Health, and VA NHCU interdisciplinary teams may serve in this capacity.
(2) Otherwise, the interdisciplinary team will be composed of the physician primarily responsible for the patient's care, a nurse, and the social worker assigned the Respite Care Program responsibility.
NOTE: The treatment plan should be developed in conjunction with the primary caregiver.
e. The physician member of the patient's interdisciplinary team will be responsible for or will supervise the respite care of the patient. The physician along with the team members will ensure that there is coordination between the existing outpatient and/or home treatment plan and the respite care treatment plan.
(1) The respite care treatment plan can include the following:
Drug review,
Drug management,
Mental health intervention,
March 3, 1995 M-5, Part VII
Chapter 1
1-3
(d) Physical therapy,
(e) Occupational therapy,
(f) Corrective therapy,
(g) Recreation therapy,
(h) Speech therapy,
(i) Manual arts therapy, and
(j) Intravenous (IV) administration.
(2) The respite care treatment plan mandates there will not be any self-administered medication.
1.06 ADMISSION GUIDELINES
The following guidelines define admission criteria:
a. The patient's caregiver is in need of relief from the day to day patient care tasks.
b. The patient is suffering from a chronic illness and/or has a prolonged recuperation from surgery or an injury incurred from an accident.
c. The patient must be determined eligible for medical center or nursing home care under 38 Code of Federal Regulations (CFR) 17.47. NOTE: Eligibility criteria are published in M-1, Part I, Chapters 4 and 12.
d. Respite care, as a form of medical center or nursing home care, will follow the same priorities that are used for all hospital and nursing home care. In accordance with 38 CFR 17.49, the Under Secretary for Health has established priorities for admission to hospital and nursing home care. These priorities are published in M-1, Part I, Chapter 4.
e. Patients admitted directly from the community and not currently known to VA will have a physical assessment completed immediately.
1.07 TERMINATION OF RESPITE CARE
Termination from respite care will occur when the patient is:
a. Released to the caregiver (home), or
b. Transferred to another level of care because the:
(1) Caregiver will no longer be able to provide care to the patient;
(2) Patient becomes acutely ill; or
(3) Patient becomes terminally ill and the anticipation of death prevents discharge from hospital or nursing home care.
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