Battle Creek VA Medical Center(269) 966-5600 ext. 35303(269) 223-5303

Home Based Primary Care

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TABLE OF CONTENTS

Page

Welcome to Home Based Primary Care --------------------- 3

HBPC Staff Members ------------------------------------------ 3

Hours of Operation --------------------------------------------- 4

Mission and Objectives of HBPC ---------------------------- 6

HBPC Patients’ Rights ----------------------------------------- 7

HBPC Patients’ Responsibilities ----------------------------- 8

Services Provided ----------------------------------------------- 10

Who Are Potential Candidates? ------------------------------- 13

Care by HBPC --------------------------------------------------- 13

HBPC Transfers and Discharges ----------------------------- 15

Medications ------------------------------------------------------ 16

Medication Refills ---------------------------------------------- 16

Cost of Care ------------------------------------------------------ 19

Enrollment Priority Groups ------------------------------------ 20

Medical Equipment --------------------------------------------- 22

Patient/Family Pain Bill of Rights ---------------------------- 22

How to be a Team Worker ------------------------------------ 23

Caregiver Support Services ------------------------------------ 24

Advance Directives --------------------------------------------- 25

How to Handle an Emergency -------------------------------- 26

Emergency Preparedness -------------------------------------- 26

Disposal Tips for Home Health Care ------------------------ 29

Safety Cautions for Oxygen Use in the Home -------------- 31

Fire Safety Rules ------------------------------------------------ 32

Veterans Billing Center--------- ------------------------------- 33

Frequently Asked Questions ---------------------------------- 33

Helpful Phone Numbers --------------------------------------- 35

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WELCOME TO HOME BASED PRIMARY CARE (HBPC)

The HBPC team of the Battle Creek VA Medical Center is happy to

welcome you to the Home Based Primary Care Program (HBPC). HBPC is a

specialized program that provides primary case-managed care to eligible Veterans

in the comfort of their own home.

The program uses a team of health professionals who work together to

develop an individualized plan of care for each Veteran. Veterans admitted to the

program will be provided with the services of a registered nurse, mid-level

provider, social worker, psychologist, registered dietitian, and rehabilitation

therapist and others as new needs are later identified. HBPC Veterans will

continue to receive their medical management and care from their assigned

Primary Care Provider in the outpatient clinic. The HBPC Pharmacist will assist in

reviewing of all your medication.

Members of the team will visit the patient at their home. Visits are made

according to the Veteran’s needs. The team will instruct the patient and

family/caregiver, and will check to see how they are doing.

HBPC STAFF MEMBERS

RN/ Care Manager: _________________________________

Mid-Level Provider: ________________________________

Social Worker: _____________________________________

Psychologist: _______________________________________

Occupational Therapist: ______________________________

Kinesiotherapist: ____________________________________

Registered Dietitian: _________________________________

Other:______________________________________________

HBPC Nurse Manager: ________________________________

HBPC Lead Program Support Assistant: __________________

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HOURS OF OPERATION

Monday through Friday

(closed Federal Holidays and weekends)

7:30 am – 4:00 pm

TELEPHONE NUMBERS

(269) 966-5600 ext. 35303

or

1-888-214-1247 ext. 35303

or

1-269-223-5303 (direct line)

In the event of a LIFE THREATENING EMERGENCY, call 911 so that you can

be taken to the nearest hospital. Ask your family, friends, or caregiver to notify the

HBPC Office of your need for emergency care. When your condition stabilizes,

ask your doctor at the hospital to call your primary care physician or Medical

Officer of the Day to discuss transfer to the VA Medical Center.

WHAT IF YOUR HEALTH PROBLEM IS NOT AN EMERGENCY?

You may call the HBPC office Monday through Friday between 7:30 a.m.

and 4:00 p.m. at (269) 966-5600 extension 35303 or (269) 223-5303. If staff does

not answer your phone call, leave your name and your message on voicemail and

someone will call you back as soon as they can.

If it is after hours, on a federal holiday or on the weekend, the phone

messages will be checked the following business day and passed on to the

appropriate team member. Each patient is assigned a case manager who is

responsible for assisting the Veteran in managing his/her home health care.

If it is after hours and you are not feeling well but know it is not emergent or

you have questions regarding appointments and/or medications, as a VA patient,

you may call Telecare. Please follow these instructions.

Telecare Service: 1-888-838-6446

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THIS SERVICE IS PROVIDED BY THE DEPARTMENT OF VETERANS AFFAIRS FOR

YOU, THE VETERAN, AND YOUR CAREGIVER/FAMILY.

If you have any of the following questions please call :

* After office hours Monday - Friday 4:00 pm –8:00 am.

* Holidays and weekends 24-hours/day availability.

When calling this number, expect the following prompts.

*If you are having a medical emergency, hang up and dial 911 or call your local ambulance.

If you have a touch-tone phone make a selection from the following menu

If you do not have a touch-tone phone, please stay on the line and the next available agent will

assist you.

Press 1 -If you have a call about a prescription.

Press 2 - If you have called about an appointment.

Press 3 - If you are returning a call to the clinic and you have a question

about benefits or administration questions.

Press 4 - If you are ill and need assistance or have a medical question

about your medications, tests or treatment and would like to speak

to a nurse.

Press 5 - If you would like the menu repeated.

All your information will go to your provider the next business day.

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HOME BASED PRIMARY CARE MISSION

We are committed to providing primary care in the home to our Veterans who have

difficulty with traditional clinic care because of their chronic illness and needs.

These services will be provided with dignity and compassion that promotes trust

and respect.

GOALS OF HBPC

1. Promote the Veteran’s maximum level of health and independence by providing

comprehensive care and optimizing physical, cognitive and psychosocial function.

2. Reduce the need for and providing an acceptable alternative to hospitalization,

nursing home care and emergency and outpatient clinic visits through longitudinal

care the provides close monitoring, early interventions and a therapeutic safe home

environment.

3. Assist in transition from a health care facility to the home by providing patient

and 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 services including Home Telehealth, as appropriate.

4. Support the caregiver in the care of the Veteran.

5. Meet the changing needs and preferences of the Veterans and family throughout

the course of the chronic disease, including through the end of life

6. Enhance the Veteran’s quality of life through symptom management and other

comfort measures.

7. Allow the Veteran the option of dying at home rather than in an institution

which may require referrals to appropriate community agencies and resources to

facilitate this fully.

8. Prevent unnecessary re-admissions and /or urgent care appointments by

utilizing the skills of the entire HBPC interdisciplinary team. This may include

rapid recognition of caregiver strain and utilization of VA Respite services.

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HBPC PATIENTS’ RIGHTS AND RESPONSIBILITIES

AS A PATIENT IN THE HOME BASED PRIIMARY CARE PROGRAM,

YOU HAVE THE RIGHT TO:

Be cared for with respect and kindness.

Be told about your health problems.

Be told how your health problems are usually treated.

Be told what you can expect from treatment.

Agree to your treatment.

Refuse any part of your treatment.

Be told what will happen to you if you refuse any treatment.

Have your communication needs met.

To receive information in a manner that he or she understands

Privacy. No one except the court can find out about your health problems

unless you give written permission.

Refuse to take part in any research studies.

Complain if you feel your rights have been denied.

Be discharged from the HBPC program at any time you wish.

Play an important role in the development of your plan of care/treatment

plan.

Expect that the home care staff will respect your privacy.

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Make known and complete “Do-Not-Resuscitate”/Advance Directives with

the HBPC team.

Request an “ethical consultation” for any ethical issues related to your health

care.

AS A PATIENT IN THE HOME BASE PRIMARY CARE PROGRAM, YOU

ARE RESPONSIBLE FOR:

Treating the HBPC team and Department of Veteran Affairs/Community

Based Outpatient Clinic staff and property with courtesy and respect.

Within the best of your abilities, please make sure the home is safe for the

healthcare provider.

No smoking before and during the HBPC team member home care visit.

Controlling any pets that may be aggressive and/or bite.

Informing us of any known unsafe activity in the area so that we can take

necessary precautions.

Asking questions and providing feedback about any part of your care or

services, needs, and expectations.

Telling the HBPC team about any changes in your condition or how you are

feeling.

Telling the HBPC team about any other health problems you have had in the

past.

Telling the HBPC team all about the medicines and remedies you are using.

This includes items purchased off the shelf including such items as vitamins

and supplements, etc…

Following the HBPC team’s instructions and participating in the

development of your HBPC plan of care.

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Letting the HBPC team know if you are having problems following any

instructions or letting the HBPC team know if you decide not to follow some

of the team’s instructions.

Understanding and accepting consequences for the outcomes if you do not

follow the care, services, or treatment plan.

Advising the HBPC team of your “Do-Not-Resuscitate”/Advance Directive

status.

Contacting the staff or HBPC Office if you are unable to keep an

appointment.

PROCESS for Complaint/ Concerns or Compliments about HBPC

It is important, that you contact the HBPC Nurse Manager if you have any

compliments, comments, suggestions, concerns or complaints about the HBPC

services. You may write or call the HBPC Nurse Manager at:

VA MEDICAL CENTER

ATTN: HBPC NURSE MANAGER

5500 ARMSTRONG ROAD

BATTLE CREEK MI 49037

269-966-5600 or 1-888-214-1247 at extension 35303 or 269-223-5303

It is our hope that we are always able to address your needs/concerns/questions or

complaints at the Medical Center level. Any compliments will be passed to the

involved team member. You may choose to write a letter complimenting them that

will be included in their personal evaluations.

If you do not feel satisfied after you have discussed your concern with the HBPC

Nurse Manager you may contact the Battle Creek VAMC Patient Representative at

269-966-5600 or 1-888-214-1247 at extension 35303 or 269-223-5303.

The Joint Commission performs surveys of the HBPC to assure we are meeting the

expected standards of care for patients in the home setting. If at any time you want

to communicate a compliment or concern to the Joint Commission regarding any

aspect of your VA care you may contact them at:

Joint Commission at 1-800-994-6610 or at complaint@jc.org.

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SERVICES

PROVIDED

MEDICAL: Your

primary care provider is responsible for your medical care. He/she is responsible

for admitting you to the program, referring you to other specialty clinics and

determining when to transfer or discharge you from HBPC. He/She will continue

to require you to come into the outpatient clinic for necessary appointments with

your Primary Care Provider at least annually.

NURSING: The nurse will visit you at home to see what your needs are. He/she

will teach you and your caregiver how to recognize and to manage your health care

problems. He/she will also teach you and your caregiver how to do home nursing

procedures and will follow your condition. He/she will assess you at each of your

visits to see how you are responding to the education and treatments you have been

receiving from HBPC. He/she will review with you your plan of care every 90

days and will make sure you have a current copy of the plan and review and

provide a current copy of your prescribed medications, over-the-counter

medications, and supplements each nursing visit.

MID-LEVEL PROVIDER: The Advanced Practice Nurse (APN) or Physician

Assistant (PA) will be available to address any significant changes in your health

with a visit to you in your home or by phone consultation by your Registered

Nurse. She/he will work collaboratively with your Primary Care Provider in your

medical care needs.

SOCIAL WORK: The Social Worker will assist you and your family in coping

with the stresses that often come about with an illness and disability. Often there

are needs that you, your family, and the HBPC team identify which we are unable

to help with. Examples of these are referrals for Meals on Wheels, transportation

services, personal care aides, housekeeping, etc. The Social Worker can also

educate and refer you to other services in the community. The Social Worker will

work with the caregiver to assure VA Respite services are used when needed to

support the Veteran in remaining in home as long as possible. She/he may help

your caregiver to identify a support group to help with changes they are

experiencing also. They may do some individual counseling for depression and

life changes if you experience a need for these.

Remember, it is our job to keep you informed of the

facts and consequences of your decisions, and it is

your right to ask questions.

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PSYCHOLOGIST: The Psychologist will evaluate you for your on-going ability

to function at home, assist you with such issues as adjusting to illness, depression

that can be situational related to life style changes and or chronic, and various other

needs that present as a chronic diseases progresses. She/he can provide you an

opportunity to discuss issues and concerns you have that may be preventing you

from having the quality of life you desire. She/he will conduct various

assessments that will help the team to assure they are addressing your needs that

are important to you.

OCCUPATIONAL THERAPY: The Occupational Therapist (OT) will provide

an assessment of your functional status and home environment with emphasis on

safety and accessibility. If you are at risk for falls the OT will assess your home

for potential safety concerns that may contribute to an injury if you do have a fall

and discuss how to make changes to promote your safety. The therapist will

provide patient health education, adaptive or durable medical equipment,

therapeutic home programs and recommendations for structural modifications

when they are assessed as a need.

KINESIOTHERAPIST: The Kinesiotherapist (KT) may be involved in your

HBPC plan if you are identified as having needs involving ambulation, safe use of

assistive devices, falls or other areas the nurse assesses involving your ability to be

mobile and or transfer safely. KT may be involved in teaching positioning and

range of motion to your caregivers if you require this.

NUTRITION SERVICES: A dietitian will perform a nutritional assessment to

assure you are eating the right foods for your healthcare needs as well as to serve

as a resource for you about eating habits that may influence your health. She/he

will provide education on special diets, possible interactions between medications

and some of the foods you eat. As indicated, the dietician will:

- Offer advice about the purchase and evaluation of food.

- Teach you and your family about menu planning and food preparation.

- Work with you to resolve nutritional problems through referrals to other

community organizations such as Meals on Wheels.

- Will work with your primary care physician to help you to decide if your

diet should be changed. This may be necessary due to the effects some foods may

have with your medicine.

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PROSTHETICS SERVICE: The Prosthetics Service issues adaptive equipment

to you, which is prescribed by a physician. Examples are wheelchairs, hospital

beds, shower chairs, etc. Prosthetic Service will make arrangements for obtaining

and delivering medical equipment and assist you in its maintenance. They will

instruct patients and caregivers in the proper use of home medical equipment. This

will be done either directly or through contracted organizations. If you have any

problems with your equipment, call the company that delivered the equipment and

help will be provided. If this fails to resolve the problem with the equipment,

Prosthetics will be able to assist you.

PHARMACIST: A pharmacist fills all HBPC prescriptions. The HBPC

pharmacist works with the team to review your medication list for medications that

may contribute to falls, create problems if taken with certain over-the-counter –

store purchased –medications and various other aspects of your medication

management program. She/he may call you at home to discuss concerns or to ask

you questions about any medications not prescribed by a VA provider.

SERVICES NOT PROVIDED INCLUDE BUT ARE NOT

LIMITED TO THE FOLLOWING:

- Personal care,

- Homemaker services (cooking, cleaning, shopping),

- Daily nursing care,

- Delivery services,

- In-home physical therapy.

- In-home IV Therapy

- Transportation

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WHO ARE POTENTIAL CANDIDATES?

1. Veterans who have chronic medical problems that require ongoing management

from an interdisciplinary team and find that traditional clinic care is not longer

working for them for a variety of reasons but usually due to the changes in health

creating fatigue and decreased function.

2. Hospitalized Veterans who require short-term follow-up home care services

before resuming their independent lives consisting of 10 visits from the RN and

HBPC Team.

3. Terminally ill patients who wish to remain at home.

4. Veterans, who are unable to manage independently in their living environment,

but have an identified caregiver if the need for one is identified.

5. Veterans must be enrolled in the VA and receive care from either the VA

Medical Center in Battle Creek or one of the VA Community Based Outpatient

Clinic.

6. Veteran lives in the HBPC service areas for the Medical Center or the VA

Community Based Outpatient Clinic.

7. Veterans whose home is the most appropriate place for care as identified by the

VA and HBPC Team.

8. Veteran’s with care needs that can be met by the HBPC Program.

9. Veterans with high risk for re-occurring hospitalizations and emergency room

visits that also have a complex chronic disease/ illness that can be managed in the

home.

CARE BY HBPC

The HBPC program provides health care follow-up to patients in their home.

We are able to do this by providing education, supervision, support to you, and

your caregiver. Your length of stay with the program will be based on your

medical condition(s) and needs. Factors that determine this are the program’s

criteria, your treatment goals, and your wishes for continued care.

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FREQUENCY OF HOME VISITS

Your first visit will be from the HBPC RN assigned as your HBPC Care

Manager RN. In some instances the HBPC Mid-Level Provider will make the

admitting assessment visit. She/he will complete a comprehensive assessment of

your needs as well as will assess your home and provide you with information

about HBPC. This information is important in helping us to develop a plan of care

with you. She/he may have another member of the team visit you at this initial

visit to complete part of the interdisciplinary assessment at that time. At the

conclusion of this first visit, she/he will discuss your needs with you and take that

information to the HBPC team. A plan of care will be developed for you based on

the information you give the HBPC RN as well as the orders from your Primary

Care Provider, the plan of care will be reviewed with you at the next RN visit so

you can agree or disagree with the plan for you while you are in HBPC. The Plan

of Care is your plan for achieving or maintaining your ability to remain in your

home. It is based on what you identify as your needs and areas for the HBPC to

support you with that fall in the HBPC program criteria and guidelines.

Members of the HBPC team will visit you on a schedule they identify with

you as meeting your needs. Your HBPC Care Manager RN will visit you

regularly. How often visits are made depends on each patient’s needs. Each team

member to be involved in your case will make an appointment either by telephone

or during the last visit to the home. They will try to maintain a consistency on the

day of the week or month that you can expect them to visit. Team members will

make every effort to make scheduled appointments, but delays or postponements

may arise because of weather conditions and/or emergencies. In such an event, the

HBPC team member or the HBPC Program Assistant will call your home to report

any changes or delays. Please allow up to 30 minutes before or after the

scheduled time for the HBPC team members arrival. Future visits by HBPC

team members are based on the initial assessments and will be arranged with you

by each of the team members.

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HBPC TRANSFERS AND DISCHARGES

Should you be discharged from the program, the team will assist you in

obtaining further care. Follow-up care may be within the VA Medical Center or in

your community. Any plans that involve a transfer of care, referral to other

resources or discharge from the HBPC will include your active participation in the

planning process whenever possible. Neither the VA nor the HBPC receive any

money from any source when we make a referral on your behalf. The purpose for

such activity is to provide you with needed resources to care for your health.

You may be discharged from the program when:

1. You are able to return to the clinics for outpatient appointments.

2. HBPC can no longer meet the intensity of your needs.

3. The safety of the HBPC staff or patient is jeopardized and no reasonable solution can

be identified to assure to the safety. Community agencies will be asked to be involved in

these cases to address the safety concerns prior to the actual discharge from HBPC.

4. You move out of the HBPC service area.

5. You decide that you no longer need or want HBPC services.

6. You are readmitted to the hospital longer than 16 days. When you are discharged

from the hospital, you will be re-evaluated for admission to HBPC. Your needs at that

time may require you to have home care from an acute community agency. When the

acute agency is no longer required you may request to be re-evaluated for re-admission to

HBPC to have your chronic medical needs addressed.

In any case of discharge, we will help you arrange for needed care. We will ask

you to sign a release of information so that we may provide whomever will be assuming

your care with copies of your medications, the plan of care and any additional VA

records they require in order to assume your care.

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A MESSAGE TO OUR VA PATIENTS REGARDING

MEDICATIONS

Your medications are important to your health. They help keep you well

and/or free of pain. Therefore if you have a problem with your medicine, call the

pharmacy at 1-888-214-1247 extension 35500. Pharmacy hours are from 8:00 am

– 4:30 pm.

All non-service connected Veterans and Veterans less than 50% service

connected will be charged a pharmacy co-pay for every 30-day or less supply of

medicine prescribed for their non-service connected disabilities. Persons over 50%

service connected are exempt from co-payment. If you currently have a pharmacy

co-pay that will continue.

If you run out of medication before you receive it in the mail, you may have

a family member or friend come to the VA to pick up a limited supply of the

medication until you receive the medicine in the mail. Also, when the pharmacy is

closed, after 4:30 p.m. Monday through Friday, or weekends or holidays, Medical

Officer of the Day (MOD) on duty for the week-end may be contacted and asked to

assist you. He/she may arrange for the Pharmacist on duty to provide enough

medication to make it through the week-end. Your family member will need to

bring you in to pick these up at the Battle Creek VA Medical Center. Therefore it

is important for you to assure you follow the process for re-ordering your

medications. If you have a problem with this, please tell your HBPC RN so they

can assist you and develop a plan to assure your medications are re-ordered timely.

MEDICATION REFILLS

1. Mail, call, or access online at http://www.myhealth.va.gov to have your refills

filled at least 2 weeks before you need the prescription

2. Mail your refill slips to the following address before you are out of your

medicine:

Battle Creek VAMC

Pharmacy Service (119)

5500 Armstrong Road

Battle Creek, MI 49015

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3. Please remember: Prescription refills are not sent automatically. You must

make a refill request in order to obtain your refills.

4. Call on the phone using the automated reordering system described below.

If you have any questions or concerns, please ask your pharmacist.

*You must have a touch tone phone NOT a rotary dial phone to

refill your medications.

1. Dial 1-888-214-1247.

2. A voice will say:

a. Hello. Welcome to the Battle Creek VA Medical Center. If you know the

extension of your party you may enter it at any time enters “35500”. Then please

enter your social security number and when you are finished press the pound sign

(#). To correct your social security number press star (*).

b. For appointment information, press 1. (NOTE: You will only be told the date

and time of the appointment, not what the specific clinic appointment is.)

c. For pharmacy prescriptions press 2.

d. For account balance information press 3.

3. If you select the #2 option for pharmacy prescriptions you will hear:

a. To request a Refill of a prescription press 1. **Choose this to have your

refills mailed to you. ** Enter in the prescription number located on the top left

corner of the medicine bottle. Do not enter any letters that may be at the end of

your prescription number.

(1). If you press 1 or 2, you will be asked to type in the prescription number

followed by the pound sign (#). If you need more than one medication refill, press

the pound sign (#) after each request.

(2) After you enter the prescription number and the pound sign (#), wait a

moment and a voice will tell you if the prescription cannot be filled. If it cannot be

filled, you must then contact personnel listed below.

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b. To check on a prescription press 2. **Choose this to check the status of your

prescription. ** (IF YOU HAVE JUST REQUESTED YOUR

PRESCRIPTION REFILL, ALLOW 24 HOURS BEFORE CHECKING

THE STATUS)

c. To speak with pharmacy personnel press 0 then ask for the pharmacy.

4. Procedures if no refills remain on your prescription or you need medication

changed:

a. Call 1-888-214-1247 from 8:00 am to 4:30 pm Monday through Friday.

(1) Team A/C ext 31895

(2) Team B ext 33873

(3) Mental Health ext 33681

b. Your requests will be forwarded to your primary care provider.

5. The medication will be mailed to you within 7-10 days unless you specifically

request to pick up the medication. If there is a problem with the request, someone

will contact you.

a. Approval of medicine renewals depends on the type of medicines and your

medical history.

6. Patient Disposal of Medications. The pharmacy cannot accept any

prescription bottles, whether full or empty, due to infection control and

patient privacy issues.

a. Please dispose of unneeded medication by mixing them in a non- viewable

container such as a coffee can or laundry soap container. Add something such as

old coffee grounds or kitty litter to them. Be sure to remove any labels from the

empty bottles/ containers for your medications and destroy them by shredding to

decrease identity theft risk.

7. If your medication looks different from what you have received in the past

please contact the Pharmacy at 1-888-214-1247 ext. 31718.

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8. Procedure if a local or national disaster occurs: the Pharmacy has back-up plans

to make sure you receive your medications if a local or national disaster should

occur. Please follow the same procedures for obtaining refills as above if

appropriate. Please call the Pharmacy if you have any questions if such an event

should occur.

9. A form is provided in the HBPC folder to assist you with having the information

available for re-ordering your medications.

COST FOR CARE

1. In most cases there is no charge for HBPC care. HOWEVER, if you have

health insurance, the VA will bill insurance carriers for the cost of medical care for

a Veteran’s non service-connected condition. Payments from insurers will be

considered paid in full. Veterans will not be charged for the unpaid portion of the

bill. If there is a charge for your home care, you will be billed monthly by the VA

Medical Center. Please remember that if you have a co-pay for your outpatient

clinic appointments you will have a co-pay for HBPC. If this is a concern for you,

please discuss this with the HBPC RN or SW. We will take this into consideration

when team members are planning your visits and make very effort to coordinate

visits.

2. What you can do if you can not afford to pay co-pays:

a. The first option is to request a waiver of the co-pays you currently owe. To

request a waiver, you must submit proof that you can’t financially afford to make

payments to the VA. Contact the Revenue Coordinator at the VA health care

facility where you receive care for more information.

b. The second option is to request a hardship determination so we won’t charge

you in the future. If you request a hardship, you are asking VA to change your

Priority Group assignment. You will need to submit current financial information

and a decision will be made based on the information you provide. You may

contact the Enrollment Coordinator at your local VA for more information.

c. The third option is to request a compromise. A compromise is an offer and

acceptance of a partial payment in settlement and full satisfaction of the debt as it

exists at the time the offer is made. Most compromise offers that are accepted

must be for a lump sum payment in full 30 days from the date of acceptance of the

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offer. You may contact the Enrollment Coordinator at your local VA for more

information.

ENROLLMENT PRIORITY GROUPS

1. Group 1 – Veterans with service-connected conditions rated 50% or more.

Veterans determined by VA to be unemployable due to service-connected

conditions.

2. Group 2 – Veterans with service-connected conditions rated 30% to 40%.

3. Group 3 - Former POWs

a. Veterans with service-connected conditions rated 10% to 20%.

b. Veterans discharged from active duty for a disability.

c. Veterans awarded special eligibility under Title 38 U.S.C. 1151.

d. Veterans awarded the Purple Heart

e. Veterans award the Medal of Honor (MOH)

f. Veterans whose discharge was for a disability incurred or aggravate in the

line of duty.

4. Group 4 – Veterans receiving aid and attendance or housebound benefits.

Veterans determined to be catastrophically disabled

5. Group 5 – Nonservice-connected and noncompensable service-connected

Veterans rate 0% disabled with annual income below the Va's and geographically

(based on your resident zip code) adjusted income limits.

a. Veterans receiving VA pension benefits.

b. Veteran eligible for Medicaid programs

6. Group 6 – Compensable 0% service-connected Veterans

a. Veterans exposed to Ionizing Radiation during atmospheric testing or

during the occupation of Hiroshima and Nagasaki

b. Project 112/SHAD participants

c. Veterans who served in the Republic of Vietnam between January 9,1962

and May 7,1975

d. Veterans of the Persian Gulf War who served between August 2, 1990 and

November 11, 1998

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e. Veterans who served on active duty at Camp Lejeune for not fewer than

30 days beginning August 1, 1953 and ending December 31, 1987

f. Veterans who served in a theater of combat operations after November 11,

1998 as follows:

1) Currently enrolled Veterans and new enrollees who were discharged

from active duty on or after January 28, 2003, are eligible for the enhanced

benefits for 5 years post discharge.

2) Combat Veterans who were discharged between January 2009 and

January 2011, and did not enroll in the VA health care during their 5 year period of

eligibility have an additional one year to enroll and receive care. The additional

one-year eligibility period began February 12, 2015 with the signing of the Clay

Hunt Suicide Prevention for America Veterans Act.

7. Group 7 – Veterans with gross household income below the geographically-

adjusted income limits (GMT) for their resident location and who agree to pay

copays.

8. Group 8 – Veterans with gross household income above the VA and the

geographically-adjusted income limits for their resident location and who agrees to

pay copays.

a. Veterans eligible for enrollment:

1) Noncompensable 0% service-connected:

Subpriority a: Enrolled as of January 16, 2003, and who have

remained enrolled since that date and/or placed in this sub priority due to changed

eligibility status

Subpriority b: Enrolled on or after June 15, 2009 whose income

exceeds the current VA or geographic income limits by 10% or less

Nonservice-connected and:

Subpriority c: Enrolled as of January 16, 2003, and who have remained

enrolled since that date and/or placed in this sub priority due to changed eligibility

status

Subpriority d: Enrolled on or after June 15, 2009 whose income

exceeds the current VA or geographic income limits by 10% or less

b. Veterans not eligible for enrollment:

1) Veterans not meeting the criteria above:

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Subpriority e: Noncompensable 0% service-connected (eligible for care

of their SC condition only)

Subpriority g: Nonservice-connected

If you have any questions, please call the Veterans’ Service Center at 1-888-214-

1247 ext 35407 for means test enrollment information.

MEDICAL EQUIPMENT

1. Usually the discharging provider will order equipment before you go home.

However, medical equipment can be obtained after discharge if you are eligible

and entitled to this equipment. The Prosthetic Service at the Battle Creek VA

Medical Center has the responsibility for issuance of durable medical equipment,

sensory aids, and prosthetic and orthotic devices. The service is also responsible

for the administration of the home oxygen therapy program. HBPC will assess for

special equipment to promote safety and increase your independence with

activities of daily living. If you are on Home Oxygen ordered through the VA you

will be expected to have an evaluation of your need annually to assess you are on

the correct liter flow as well as that you are still in need of it. You will be at risk of

loosing you Home Oxygen from the VA if you do not have this assessment.

2. The Prosthetic Service will coordinate delivery and setup of home medical

equipment. You will be instructed in the proper use and care of medical equipment

by trained staff.

3. Should you have problems, call (269) 966-5600 or 1-888-214-1247 ext 33898

their working hours are 8:00 am – 4:00 pm Monday – Friday, excluding legal

holidays and weekends. Let the HBPC team members know if you have had to

call about equipment issues so they can contact Prosthetics to assure it is

addressed.

PATIENT/FAMILY PAIN BILL OF RIGHTS

AS A PATIENT IN HOME BASED PRIMARY CARE YOU CAN EXPECT:

1. Your reports of pain will be believed.

2. You will be given information about pain and pain relief measures. Not all pain

management involves medications. We will teach you ways to help with pain

management that do not require medication.

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3. Our concerned staff is committed to the prevention and/or management of your

pain.

4. Your healthcare professional will respond quickly to your reports of pain.

5. Your healthcare professional is committed to effective pain management.

AS A PATIENT IN HOME BASED PRIMARY CARE YOU ARE

RESPONSIBLE FOR:

1. Asking your healthcare professional (MD, Mid-Level, RN, LPN) what to expect

regarding pain and its management.

2. Discussing your pain relief options with your healthcare professional.

3. Working with the healthcare professional to develop a pain management plan.

4. Asking for pain relief when pain first begins.

5. Helping your healthcare professional assess your pain promptly.

6. Telling your healthcare professional if your pain is not relieved.

7. Telling your healthcare professional if you have any worries about taking pain

medication.

8. Take your pain medications as prescribed and to utilize non-medication pain

management strategies the HBPC team will help you learn.

HOW TO BE A TEAM WORKER

Here are some tips that you can use to assist your HBPC team help you get better.

Before the HBPC visit: On the day of the HBPC visit:

Write down the questions you

want to ask

Follow all directions. Don’t eat

or drink if told not to.

Have the following ready for

your nurse:

Wear clothes that are easy to

take off and put on.

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a. What is the

problem/symptom? You or your caregiver should

be ready to take notes.

b. When did it start? Tell us if you don’t understand

something.

c. Does anyone else at home

have the same problem? Tell us if you can’t or won’t do

what we suggest.

d. What do you think is

causing it?

e. Have you tried anything to

help? Did it work?

f. Are you in pain? When did

it start? How long did it

last?

g. Have you changed your diet

or exercise? Have you lost

weight?

CAREGIVER SUPPORT SERVICES

1. If you are a caregiver, you and your patient are very important to us.

2. Giving care to another person can be very rewarding. It can also be very hard

on you. You need to take time for yourself, mentally and physically. You may

need some help for yourself at this time.

3. If you feel that you need supportive services, tell members of the HBPC team

when they visit you at home or call the HBPC office at (269) 966-5600 extension

35303. We may be able to refer you to support groups in your area or to an adult

day-care program. The HBPC Social Worker will do a caregiver burden

assessment with you on admission to the HBPC but if you feel you have needs at

any time to help you with your feelings of stress, please let the team know.

4. The VA also has Respite Services available that you may choose to take

advantage of in order to assist you with the responsibility and strain often

associated with being a caregiver full time.

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ADVANCE DIRECTIVES

1. A serious illness affects not only you, but your family as well. Have you

thought about what kind of care you would want, and have you talked about your

decisions with your family?

2. Advance Directives are legal documents that let your doctors and other

healthcare providers know how you want to be cared for in case something

happens and you are unable to make decisions about your healthcare for yourself.

3. The Department of Veterans Affairs and the Battle Creek VA Medical Center

recognize that every person has the right to choose and direct his or her medical

care. This includes the option to refuse life prolonging medical treatments or

having these treatments stopped after they have begun.

WHAT ARE ADVANCE DIRECTIVES?

1. A durable power of attorney for healthcare lets you decide who you would

like to make decisions regarding your treatment should you be unable to make the

decision for yourself.

2. A living will lets you decide whether you would want healthcare professionals

to give you any treatments or procedures to save or prolong your life, or whether

you would like to have these treatments withheld or limited.

3. A non-hospital Do Not Recessitate (DNR) is a document signed by your

medical provider indicating your wishes for others not to perform cardiopulmonary

resuscitation if your heart stops. This is a State of Michigan form that HBPC can

assist you with.

COMMUNICATING YOUR WISHES IS THE MOST IMPORTANT ISSUE

Be sure to keep a copy of your Advanced Directive and/or State of Michigan

DNR available in case an emergency occurs. You may want to post a copy of

the State of Michigan DNR on your Refrigerator or in a location that will be

visible to emergency personnel.

An educational booklet on Advanced Directive is provided to you in your HBPC

Folder. If you have further questions or wish assistance on Advanced Directives or

State of Michigan DNR please let the HBCP RN or Social Worker know.

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HOW TO HANDLE AN EMERGENCY

1. A medical emergency is an unexpected event that requires immediate medical

care. Examples of emergencies are chest pains that are not relieved by medication;

unconsciousness; seizures; falls that result in serious injury; and acute shortness of

breath or severe bleeding, blood sugar below 40 with a change in awareness or

greater than 400 with changes in awareness. If any of these problems occur or any

others that you feel are emergent or life threatening, call 911 or your local

Ambulance.

EMERGENCY PREPAREDNESS FOR PERSONS

WITH SPECIAL NEEDS

1. Contact your local emergency management office. Ask them to put you on

their register of people with disabilities. Then they can locate you and will assist

you more quickly in a disaster.

2. Prepare a kit (in addition to an emergency kit) that includes a 14-day supply of

all medications. Be sure to rotate these medications with your daily supply every

30 days so they do not expire.

3. Have a whistle attached to a flashlight.

4. Store a writing pad and pencils, if you have a severe speech, language, or

hearing disability. Then you can communicate with others.

EMERGENCY PREPAREDNESS AND

HOME SAFETY TIPS

1. Never wear loose clothing during cooking.

2. Do not store items on high shelves.

3. Turn the pot handles toward the back of the stove during cooking.

TO REDUCE THE RISK OF INFECTION

We want you and your loved ones to be healthy and infection free. Please wash

your hands frequently to avoid the spread of germs. Remember to cover your

mouth when you cough, and cover sneezes with a tissue. We also encourage you

to get your flu shot yearly.

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HOME OXYGEN

If you are receiving Home Oxygen Therapy, clean the filters on the Oxygen

Concentrator weekly and replace your nasal cannula when it begins to look soiled

or discolored or if you have been treated for an infection. Nasal cannula should be

replaced weekly whether they are discolored or not.

WHAT TO DO IN CASE OF FLOODING, TORNADOS OR

OTHER NATURAL DISASTERS

Natural disasters come with very short notice. It is natural to worry about

floods or power failures if you are bed-or wheelchair-bound Veteran. Preparing

yourself early is the best way to get out of a natural disaster with little or no

problems.

We have included “Emergency Preparedness for Home-Care Patients” in

your admissions packet as a guide to prepare for disasters. You can also call your

county Emergency Services office. They will be glad to help you in your

preparations. They can also advise you as to which local shelters can support your

medical condition. Just remember to call them early. If you call them during a

disaster for advice, you’ll probably get a busy signal.

Some things to consider before the Natural disaster occurs:

Water

Store one gallon of water per person per day (two quarts for drinking, two

quarts for food preparation/sanitation)*

Keep at least a three-day supply of water for each person in your household.

Food

Store at least a three-day supply of non-perishable food. Select foods that

require no refrigeration, preparation or cooking and little or no water. If you must

heat food, pack a can of sterno (a heat source). Select food items that are compact

and lightweight.

Include a selection of the following foods in your Disaster Supplies Kit:

Ready-to-eat canned meats, fruits and vegetables

Canned juices, milk, soup (if powdered, store extra water)

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Staples—sugar, salt, and pepper

High energy foods--peanut butter, jelly, crackers, granola bars, trail

mix

Vitamins

Foods for elderly persons or persons on special diets

Comfort/stress foods—cookies, hard candy, sweetened cereals,

lollipops, instant coffee, tea bags

First Aid Kit

Assemble a first aid kit for your home and one for each car. You may

contact your local American Red Cross chapter to obtain a basic first aid manual.

Supplies

There are six basics you should stock in your home: water, food, first aid

supplies, clothing and bedding, tools and emergency supplies, and special items,

such as prescription medications.

Keep the items that you would most likely need during an evacuation in an

easy-to-carry container. Possible containers include a large, covered trash

container, a camping backpack, or a duffle bag.

Suggestions and Reminders

Store your emergency supplies in a convenient place known to all family

members.

Change your stored water supply every six months so it stays fresh.

Rotate your stored food every six months.

Re-think your emergency kit and family needs at least once a year. Replace

batteries, update clothes, etc.

Ask your physician or pharmacist about storing prescription medications.

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DISPOSAL TIPS FOR HOME HEALTH CARE

1. Needles, syringes, lancets, and any other sharp objects are often referred to as

“sharps”. Once these sharps have been used, they should be disposed of in a red

hard plastic or metal container with a secured lid. The lid should fit tightly. Do

not use clear plastic or glass containers. DO NOT recap needles before disposing.

a. Examples of sharps containers: Plastic laundry detergent bottles and coffee

cans. DO NOT use plastic Milk containers- they are not thick enough to prevent

accidental puncture of the dirty needles or sharps.

b. If a coffee can is used, be sure to secure the lid with heavy tape before

putting it in your regular trash.

c. Never recycle containers used for sharps.

d. Keep containers with sharp objects in them away from children and pets.

e. Check with your community or state environmental agency. They may have

some special requirements that you’ll need to know.

f. The Pharmacy cannot accept any used syringes or needles from patients.

g. Outdated medications, medications that are expired and any over-the-counter

medications you are no longer suppose to be taking should be disposed of by

dumping them in a container such as a coffee can, milk jug or other container that

can be closed. Mix them with kitty liter, old coffee grounds or some other noxious

substance, close the container tightly and dispose of in your garbage.

2. It is also recommended that soiled items such as:

a. bandages or dressings,

b. disposable sheets or pads,

c. incontinent briefs,

d. medical gloves

e. place in a heavy plastic bag that is securely closed before putting it into your

regular trash.

f. Fasten the bag securely at the top.

g. Place the bag with your other trash.

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h. Don’t attempt to burn soiled items.

3. Items that are known to be soiled with infectious waste may need special

disposal. Again, check with your community or state agency before throwing

these items in your trash.

4. Michigan Environmental Protection Agency address and number:

Michigan Department of Environmental Quality

Division Name, Employee Name (where applicable)

525 West Allegan Street

P.O. Box 30473

Lansing, MI 48909-7973

(517) 373-7917

1-800-292-4706 (within Michigan)

or 1-517-373-7660 (outside Michigan

5. Michigan Environmental Protection Agency for Region 5 (IL, IN, MI, MN,

OH, WI) address and phone number:

Environmental Protection Agency

77 West Jackson Boulevard

Chicago, IL 60604-3507

Phone: (312) 353-2000

Fax: (312) 353-4135

Toll free within Region 5:

(800) 621-8431

http://www.epa.gov/region5/

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SAFETY CAUTIONS FOR OXYGEN USE IN THE HOME

OXYGEN DOES NOT BURN, BUT IT MAKES EVERYTHING NEAR IT

BURN FASTER! FOLLOWING THESE RULES COULD SAVE YOUR

LIFE!

Do not smoke or use any flammable items such as candles or incense within 10

feet of the oxygen.

Continuing to smoke while using oxygen may result in a referral to the VA

Medical Center Ethic committee for discussion about your safety with oxygen use

and the possible need to involve other and or evaluate you for discontinue use of

Oxygen.

The VA does have options available to assist you to quit smoking. Please discuss

this with your HBPC team members.

1. NO SMOKING and NO OPEN FLAMES in the room where oxygen is used

or within 10 feet of this room.

2. NO SMOKING SIGNS should be put on the door of the home where oxygen

is used.

3. Combustible product such as grease, oil, and alcohol should not be near the

oxygen. They can easily catch fire.

4. A smoke detector is recommended in every home, especially if you use oxygen.

5. IN CASE OF FIRE, immediately shut off the main valve of the oxygen tank or

turn off the concentrator’s switch.

6. TURN OFF flow valve or turn concentrator switch off when not in use.

7. DO NOT PUT ANYTHING AT ALL on top of the concentrator or any other

piece of oxygen equipment.

8. DO NOT USE anything electric such as razors, hair dryers, or electric pumps

while you have the oxygen on.

9. Oxygen tanks should be secured on the SAFETY BASE or rack the oxygen

company gives you. Never let the tanks stand free.

10. The company that delivers your oxygen will teach you the care of your oxygen

equipment and what to do if the power goes out. Your HBPC team should review

this with you at admission and annually while you are in HBPC.

11. Keep the name and phone number of your oxygen company near your

telephone where you can use it quickly if there’s a problem.

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FIRE SAFETY RULES

The greatest cause of death in fires is not smoke or flames; it is panic.

During a fire things are different, unfamiliar, and difficult and to ease your mind,

pre-planning is vital. Then, if there is a fire, you will be ready to act quickly and

correctly. Buy and install fire detectors for each room in your house. Your

chances of survival if there is a fire are double if you buy and install fire detectors

for each landing in your house. Test all smoke detectors weekly and change the

batteries twice a year. (A good time to change the batteries is when you change the

clock to or from Daylight Savings Time.)

Make a plan on how you and your family will get out of the house if there’s

a fire. Practice it, or at least, go over it in your mind. Periodically review your

Exit Drill in the Home with your family. Plan for at least two ways out. If an

EXIT is through a ground-floor window, make sure it opens easily. If you’re in an

apartment, know EXIT stair locations. Keep your hallways clear. Don’t use

elevators in a fire.

Tell your fire department if you use oxygen or someone is bed bound and

can’t get out in case of a fire. They may give you a sticker to put on the bedroom

window.

NEVER SMOKE IN BED! Don’t put lit cigarettes or pipes on furniture.

Be sure what you are smoking and the matches are extinguished completely.

In case of fire, get down low. Feel the door with the back of your hand

before you open it. If it does not feel hot, then crack it open. Hold your head away

and brace the door with your foot. Put your hand across the opening to test

whether the air is hot.

If hallway or other rooms seem safe, use your pre-planned exit.

If the fire escape is cut off, be calm, close doors and seal cracks to hold back

smoke using wet towels, sheets etc.

Veterans Billing Center

The Department of Veterans Affairs call center is available to answer your

billing questions. Call toll free 1-866-279-3677 their hours of operation are

Monday through Friday from 8:00 am to 8:00 pm Eastern Standard Time.

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FREQUENTLY ASKED QUESTIONS

Q. Does my placement in the HBPC program affect my VA benefits?

A. No

Q. Who is in charge of my medical care?

A. The HBPC Nurse Practitioner or Primary Care Provider is your primary

provider. She/he arranges for follow-up at specialty clinics if needed.

Q. Will all disciplines from the HBPC team visit me?

A. Yes. The provider, nurse, occupational therapist, dietitian, psychologist, and

social worker will make at least one initial evaluation visit. Further home visits

will be made based on your needs. If you are enrolled for a short time specific

need your provider will refer you to other services as indicated and available.

Q. Will a physical therapist give me therapy at home?

A. No. The VA is unable to provide this service at present. However, your

nurse/case manager or Primary Care Provider can help with a referral to meet this

need.

Q. Will the HBPC nurse come to give me a bath at home?

A. No, but the nurse will teach you or your family member how to do it. If more

help is needed, the social worker can help with referrals to home health agencies.

Q. Should I keep paying for Medicare or other hospital insurance?

A. Yes, keep your other insurance.

Q. Does the VA pay for emergency hospitalization costs at other hospitals?

A. No. The VA does not routinely pay for costs at hospitals other than its own.

Q. Can I keep my Non-VA provider?

33

A. Yes.

Q. Does the VA pay for ambulance costs?

A. No. We don’t pay for this type of service.

Q. May I keep my medical equipment such as a hospital bed or wheelchair after I

am discharged from the program?

A. Yes. You may keep the equipment as long as you need it.

Q. Does HBPC provide Meals on Wheels, house cleaning, laundry, grocery

shopping or snow shoveling?

A. No, but the HBPC social worker will help you with information and referrals if

you need these services.

Q. May I discontinue the HBPC program if I feel it no longer meets my needs?

A. Yes, and it will not affect your VA benefits.

Q. Does the VA get any money for referring me to other community services and

resources?

A. No.

Q. Can I give HBPC Staff gifts as a sign of appreciation?

A. No, your thanks are all we ever need. We need to know that we are doing a

good job. YOU took care of us and our country, HBPC is one way we can return

the favor!

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General Helpful Phone Numbers

Our goal is to give you the best possible care at all times. If you have a question,

or want to let us know how we are doing, you can reach us at:

VA Medical Center

Attn: HBPC Nurse Manager

5500 Armstrong Road

Battle Creek, MI 49037

(269) 966-5600 ext 35303

VA Benefits 1-800-827-1000

Burial, Civilian Health and Medical Program of the Department of Veterans

Affairs (CHAMPVA), Death Pension, Dependency Indemnity Compensation,

Direct Deposit, Directions to VA Benefits Regional Offices

Disability Compensation, Disability Pension, Education, Home Loan Guaranty,

Life Insurance, Medical Care, Vocational Rehabilitation and Employment

- Additional number for Vocational Rehabilitation and Employment

1-877-222-8387

Education (GI Bill) 1-888-442-4551

Health Care Benefits 1-877-222-8387

Income Verification and Means Testing: 1-800-929-8387

Life Insurance 1-800-669-8477

Mammography Helpline 1-888-492-7844

Special Issues – Gulf War/ Agent Orange/ Project Shad/ Mustard Agents and

Lewisite/ Ionizing Radiation 1-800-749-8387

Status of Headstones and Markers 1-800-697-6947

Telecommunications Device for the Deaf (TDD) 1-800-829-4833

Telecare: 1-888-838-6446

Remember, good news, bad

news, or just a question, we

want to hear from you.

35

Wyoming Health Care Center - 616-249-5300

Lansing CBOC- 517-267-3925

Benton Harbor CBOC- 269-934-9123

Muskegon CBOC – 231-798-4445

National Cemetery Administration 1-800-669-8477 1-800-749-8387

Billing 1-888-214-1247 ext 35037

Local Phone Numbers

TDD for the Deaf 1-800-829-4833

VAMC Battle Creek Information: (269) 966-5600 or 1-888-214-1247

VA Web Home Page: http://www.va.gov/

My Healthe Vet Web Site: http://www.myhealth.va.gov/

VAMC Battle HBPC: (269) 966-5600 ext 33700

VA MEDLINE plus Health Information Web Site

http://www.nlm.nih.gov/medlineplus/

For health care services, contact your nearest VA medical facility:

http://www1.va.gov/directory/guide/home.asp

Welcome to HBPC. We are privileged to serve you.

References:

a. (2005) Bath VA Medical Center HBPC Handbook

b. (1995) Channing L. Bete Co. Inc, Various Handbooks

c. Michigan State Police Emergency Management Division, A Family

Preparedness Guide