Implementing the HPPAE model in VA Social
Work Graduate Education-GRECC Pilot Project
Lorn Gingrich, LCSW-R
National Social Work Program Manager
Care Management and Social Work Services
Department of Veterans Affairs: VA Central Office
November 2, 2013
Social Work in VA
• Largest employer of social workers with nearly 11,000
master’s prepared social workers
• Largest graduate social work training program
• Train over 1100 MSW interns each year
• Offered 879 stipends last year; 49 GRECC SW stipends
• Affiliated with over 180 graduate schools of social work
• Licensed independent practitioners
• Leaders in psychosocial care of Veterans, families and
Caregivers
VETERANS HEALTH ADMINISTRATION
VA Social Work: Mission and Vision
• Mission: The mission of VA Social Work is to maximize health and wellbeing, through the use of psychosocial interventions for Veterans, Families
and Caregivers
• Vision: VA Social work will be the preeminent leader, setting standards for
innovative psychosocial care and treatment
This will be accomplished by developing and maintaining integrated
quality programs in patient centered care, informed and evidence
based practices, community partnerships, research, education, health
promotion and disease prevention
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VA Social Work: Values
Values: VA Social Workers are advocates for the optimal health and well-being of
Veterans, Families and Caregivers. Our Core Values are to:
• Respect the dignity and worth of the individual
• Appreciate the Veteran within his or her family and socio-cultural environment
• Empower the Veteran as the primary member of their health care team
• Respect the distinctive role and expertise of each member of the health care team
with the Veteran at the center
• Advocate for systems changes that are responsive to Veteran’s evolving needs with
a focus on at-risk populations
• Promote a learning environment that fosters knowledge, enhances clinical social
work practice, and advances leadership and administrative excellence
• Exemplify and model the highest professional and ethical standards
• Promote conscientious stewardship of organizational and community resources
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National Social Work Program
• Social Work is woven into the fabric of VA health care in the Department of
Veterans Affairs
• Primary focus of social workers in VA is to assist Veterans and their
families/Caregivers in resolving psychosocial, emotional and economic
barriers to health and well-being
• Social Work brings a unique program of clinical practice supported by
professional values and skills, education and training, program
development, professional standards, accountability, and research
• Social Work provides a major link for Veterans and families with VA
facilities and with the community
VETERANS HEALTH ADMINISTRATION
Today’s Veterans
55% of Veterans are 60 years old or older
Younger than 30
1M
30-44 Years old
3.3M
45-59 Years Old
5.7M
60-74 Years Old
7.7M
75 Years or older
Million
4.8M
0
2
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AGE
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10
(Under Secretary for Health, Veterans
Health Administration)
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Social Work and Care Coordination for Older Adults
 Social Workers play an integral role in care coordination and service delivery for
older adults
• Advanced illness
• Multiple chronic conditions
• Caregiver stress and strain
 Facilitate access to health and psychosocial services
• Improve health outcomes
• Decrease health care costs
• Support aging in place
 Identify resources to maximize functioning and independence
 Arrange home and community based services
 Social work expertise is critical to navigate complex health and social service
systems of care for older adults
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Caring for Older Veterans
•
VA offers an array of non-institutional and institutional home and community
focused programs to support older Veterans, their families and Family Caregivers
• Institutional Care
 Contract Nursing Home
 Residential Care
 Medical Foster Home
• Non-institutional Care
 Home Based Primary Care
 Adult Day Health Care
 Homemaker/Home Health Aid
 Respite Care
 Skilled Nursing Home Care
 Caregiver Support
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Home and Community Care Services
 Home Based Primary Care (HBPC)
• 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
 Homemaker Home Health Aide (H/HHA)
• Permits VA to pay for homemaker and home health aide assistance for
Veterans
 Veterans Directed Home and Community Based Programs
• Veteran and their family Caregiver will: manage a flexible budget; decide for
themselves what mix of services will best meet their personal care needs; hire
their own personal care aides, including family or neighbors; and purchase
items or services to live independently in the community
 Purchased Skilled Home Care
• Professional home care service that is purchased from private-sector providers
at every VA medical center
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Home and Community Care Services
 Respite
• Provides Veterans with short-term services to give the Caregiver a period of relief from
the demands of daily care for the chronically ill or disabled Veteran
 Caregiver Support Program
 Provides Veterans and their family Caregivers with a menu of VA Services such as inhome care, respite care, services to address mobility issues, education and training,
financial support, information and referral and caregiver support
 Adult Day Health Care
• A therapeutically oriented outpatient day program that provides health maintenance
and rehabilitative services to frail elderly and functionally impaired Veterans in a
congregate setting
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Community Care Services
 Community Nursing Home Contract Program (CNH)
• Provides long term care services through contracts with community nursing
homes to match the Veterans' geographic preferences and institutional long
term care needs
 Community Living Center
• Provides compassionate care to eligible Veterans with sufficient functional
impairment to require the level of service and skill available in VA Community
Living Centers (VACLC)
 Palliative Care Program
• This program is designed to focus on the quality of life and comfort for a
Veteran with an advanced disease that is life-limiting. Hospice and Palliative
Care supports a balance of comfort measures, interventions and provides
bereavement care to the Veteran's family
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Community Care Services
 Community Residential Care
• This program provides health care supervision to eligible Veterans not
in need of hospital or nursing home care but who, because of medical
and/or psychosocial health conditions as determined through a
statement of needed care, are not able to live independently and have
no suitable family or others to provide the needed supervision and
supportive care
 Medical Foster Home (MFH)
• A type of Community Residential Care (CRC) home chosen by the
Veteran who is unable to live independently, as a preferred means to
receive family-style living with room, board, and personal care;
Veteran is receiving HBPC services in the MFH
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Social Work Care Coordination with Older Veterans
• Social workers coordinate many Long-Term Care Programs:
• Community Nursing Home
• Homemaker/Home Health Aide
• Contract Adult Day Health Care
• Respite Care
• Medical Foster Home
• Caregiver Support
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VA SW/GRECC/HPPAE
• Important collaboration with the John A. Hartford Foundation’s
Geriatric School of Social Work Initiative, VA Social Work and
Geriatric Research Education Clinical Center (GRECC) and the Social
Work Leadership Institute utilizing the Hartford Practicum
Partnership in Aging Education (HPPAE) model
• Competency-based geriatric social work graduate internships
• Strengthen capacity of social work to address the health and
psychosocial needs of older adults
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Important Aspects of Care Coordination
• Early identification of psychosocial issues
• Early education and intervention
• Encourages exploration of alternatives to care
• Reduces risk for hospitalization or institutionalization
• Reduction in utilization of health care resources
• Helps monitor the status of the Veteran between provider
contacts
• Enhances connection to Veteran’s local community
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Impact of VA Social Work
• Social Workers are not just “value added”
• Social workers are essential members of interdisciplinary treatment
teams
• Social workers are critical in increasing health care supports and
service delivery and reducing cost
• Social work participates in the development of programs and
services to meet the changing needs of our Veterans resulting in
significant contributions of our profession
VETERANS HEALTH ADMINISTRATION
The VHA GRECC Program
• In the 1970s the Veterans Health Administration began planning to meet
the challenges the aging World War II Veteran population would present.
At the time the field of geriatric medicine was rather small, so to help
grow the field and develop the infrastructure necessary to handle the
complexities such a large influx of elderly patients would present the
Geriatric Research Education and Clinical Centers (GRECCs) were
developed. GRECCs were meant to attract scientists and health science
students to the field of geriatrics in order to help increase the basic
knowledge of aging, transmit this knowledge to health care providers, and
improve the quality of care delivered to elders.
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The VHA GRECC continued
•
Each GRECC contains a research component, a education component, and a clinical
component. Currently there are 20 GRECCs which compete for research grants to
conduct basic laboratory research on the origins of aging and the diseases
commonly associated with it as well as research how care is delivered to elders
and the effects of rehabilitation. GRECCs help disseminate existing knowledge of
geriatrics and new discoveries gained through research by offering regular
educational events and products such as national conferences, regional
conferences, telephone and video conferences, special fellowship programs to
train physicians in geriatric medicine, conducting grand rounds and journal clubs,
and producing peer reviewed papers and other materials such as newsletters, CDROMs, and web based presentations. The GRECCs also work with clinical staff in VA
medical centers to provide care to elderly Veterans and demonstrate new and
improved ways for that care to be delivered.
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GRECC continued
• GRECCs are not meant to be large enterprises but centers of excellence
with a core staff equaling 12 full time employees. Each year these small
research units publish hundreds of peer reviewed articles, provide
thousands of person hours in geriatric education, and are awarded
millions of dollars in research grants. More significantly they provide care
to the aging Veteran population while at the same time training many of
the healthcare professional which will provide that care for years to come
• http://www.va.gov/grecc/
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GRECC/HPPAE Pilot
• Given the synergy between the HPPAE model of geriatric graduate social
work education and the GRECC model of education, research, and
practice, tremendous opportunity to integrate
• Proposed to GRECC leadership, Dr. Kenneth Shay, and Office of Academic
Affiliations, Dr. Robert Zeiss accepted
• Partnership established in 2010:
– VA
– John A. Hartford Foundation
– Social Work Leadership Institute (New York Academy of Medicine)
• To facilitate development of advanced competencies in geriatric social
work practice in VA and encourage young social workers to enter the field
of geriatrics.
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Partnership Goal
•
•
•
Enhance education of MSW social work students to develop specific competencies
in working with geriatric populations
Framework for collaboration to advance preparation of the profession of social
work in geriatric issues
Bring together our mutual interests and complementary resources to further this
goal
– OAA- Provide student stipends
– Social Work -Provide preceptors and supervision for social work interns
– GRECCs -Provide geriatric education and interdisciplinary training
– Hartford Foundation – develop local partnerships with schools of social work
– SWLI – provide orientation, consultation and mentorship through
implementation of the HPPAE social work education model
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Pilot Project
•
Toss back to Pat for slide 17 onward
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Questions or need to contact:
Lorn Gingrich, LCSW-R
National Social Work Program Manager
Lorn.Gingrich@va.gov
(518)424-2347
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