AGING & INDEPENDENCE SERVICES

San Diego’s

Veterans Services at any Age

What is the

Veteran’s Directed Home

and Community Based

Services?

SAN DIEGO’S VD-HCBS

PROGRAM DEVELOPMENT

1 YEAR IN THE MAKING!

Technical Consultants:

• Molly Murphy, Merle Edwards Orr, Roger Auerbach, Patrick Brady

Readiness Review

• Program

o P & P

o Veteran Handbook

• Financial

Mock Referral

Program Agreement

SD-VISA

VET

VA

AISPremier

WHAT IS SELF-DIRECTION?

Veteran

Agency recruits

and manages workers

Program and

agency set tasks

Agency specifies

salary and benefits

Normal work hour schedule

Agency requires worker training

Case manager

determines needs and

services

Traditional Services

Veteran

Recruits, hires, and manages workers

Sets tasks

Specifies salary and benefits

(optional)

Assigns flexible work

hour schedule

Trains/ arranges worker training

Makes decisions

about needs and services

Self-Directed Services

6

VAMC

Sends all referrals with:

Geriatric Extended Care Assessment

Completed Case Mix

Proposed Budget

Veteran has already been informed of program

AIS’ ROLES

1. Act as intermediary between

Veteran, FMS and VA liaison

2. Provide fiscal oversight

3. Ensure program integrity

AIS’ ROLES

4. Options Counseling

• Veteran and family centered

• Interactive & decision-supportive process

• Assist Veterans to identify & understand their needs

• Establish Action Plans

VISA SPENDING PLAN

FMS- PREMIER HEALTHCARE SERVICES

AGENCY WITH CHOICE VS FE/A

F/EA WAS INITIALLY APPROVED…

What is a F/EA or Fiscal Employer Agent?

Fiscal/Employer Agent (F/EA) providers

perform various administrative and payroll

tasks to help program participants be the

Employer of Record (EOR). In this program

model, participants are the sole employers

responsible for hiring, training, scheduling

and terminating their own caregivers. This

model gives the participant the most control.

WORKER’S COMPENSATION

POLICY PURCHASE PRICE WAS PROHIBITIVE

Under F/EA model each participant had to purchase

Workers Compensation

• Most carriers wouldn’t even quote a price

• State Fund is the mandated provider and the cost

was approximately $2500

Under Agency with Choice model participants are

covered under the FMS global policy

ACL and the central VA were hesitant to approve the

AWC model

• Problems with FMS agencies “double dipping”

• Does participant maintain Employer Authority

AGENCY WITH CHOICE VS F/EA CONT..

AGENCY WITH CHOICE WAS THE PREVAILING MODEL

Agency with Choice-

“The agency and participants are co-employers of the workers

whom participants recruit and refer to the agency…” - NRCPDS

Participant maintains Employer Authority and Budget Authority

while the Agency handles the administrative burden of employing

a provider. This allows the Participant to focus on managing their

long term services and supports (LTSS).

AGENCY WITH CHOICE BENEFITS

AWC ROLES AND RESPONSIBILITIES

Agency considered the “Primary” employer

Pays Workers & Service Providers

Less Risk for Participant of claims or lawsuits

• Labor claims

• OT claims

• Workers Comp Insurance & Claims

Participant Maintains “Budget and Employer” Authority

• Considered the “Managing” Employer

Co-Employment Recognized by DOL not IRS

• Agency liable for proper employer / employee taxation

• Participant may share some liability for labor claims

WHO ARE WE SERVING?

Korean War

World War II

WHO ARE WE SERVING?

Vietnam

WHO ARE WE SERVING?

FUNCTIONAL ABILITY

ON AVERAGE

Have 6 ADL Dependencies

Have an average budget of $3111/Mo

50% of Veterans referred meet criteria for “High Needs”

50% of Veterans referred have Dementia

• Other Medical Issues include: Depression, PTSD, CHF

SURVEY OUTCOMES

Overall 90% were satisfied with all aspects

of the SD-VISA Program.

100% of Veterans interviewed indicated that

this program has allowed them to remain

safely in their home.

100% of Veterans indicated that they were

satisfied with the quality of their care.

100% reported improvement in their quality

of life.

COMPARISON: VASDHS vs. SD-VISA

HOURS OF CARE COST PER YEAR

$812,832

5M

2M

1M

800K

600K

SD VISA

VASDHS

$1,143,828

53,736

10,444

Yearly

60K

50K

40K

30K

20K

10K

SD VISA

VASDHS

51% Decrease in

Readmissions

20% Avoided SNF

Placement$1.6 M

KEYS TO SUCCESS

Committed to helping our San Diego Veterans

• Right staff

All at the table

• From beginning and continues

Communication

• Do not underestimate

the importance

Flexibility

Transparency

CHALLENGES

Sustainability

Helping Veterans think outside the box

A VETERAN’S STORY

Michael and Betsy Winniman

San Marcos, CA

“Because of the

SD-VISA Program,

I know that the VA is

100% behind me.”

~Veteran, Michael Adams

QUESTIONS?