Bonnie G. Garnette, MSW, LCSW-BACS
Program Coordinator
WHAT IS A MEDICAL FOSTER HOME?
MEDICAL FOSTER HOME
 A Medical Foster Home (MFH) is an adult foster
home combined with a VA interdisciplinary home
care team such as VA HBPC (Home-Based Primary
Care) or SCI-HC (Spinal Cord Injury Home Care),
to provide non-institutional long term care for
Veterans who are unable to live independently
and prefer a family setting.
What is Medical Foster Home? cont.
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Merging of adult foster home with VA HomeBased Primary Care (HBPC) and/or Spinal Cord
Injury Home Care program.
Person in community takes dependent veteran
into their private home, as MFH caregiver
MFH caregiver provides daily personal care,
assistance, and supervision
VA HBPC provides comprehensive medical care
and management; caregiver education
VA MFH Coordinator provides oversight
Veteran pays for MFH
How did MFH start?
 Two social workers at Little Rock VA 1999
 Problem: Veterans in HBPC decline, not safe to live
alone, refuse NH
 Opposing ethical principles
 Unsafe at home, or force out of home?
 Solution – find a willing caregiver, meet medical care
needs through HBPC
 Pilot 2004 – in Tampa, Florida and San Juan Puerto
Rico VA Hospitals
Goals of MFH
 Alternative to nursing home for certain Veterans
 Meet increasing demand for LTC through care in
non-institutional setting
 Give Veterans option to remain in family setting
 Improve quality of life for Veterans
 Veteran in safe and therapeutic environment
 Facilitate most appropriate use of VA and
community resources
 Provide longitudinal care in a home to include
end-of-life and preventative care
Benefits of MFH
 VA offers an option to nursing home care, in a less
restrictive environment
 Veteran can choose a home environment
 MFH less costly than nursing home
 Cost savings to VA for 70%+ SC
 Benefits to caregivers
 Benefits to community
Economics of MFH
Who pays for MFH ?
 MFH rates are negotiated according to level of care
and Veteran’s ability to pay
 Veteran pays for MFH
 VA works with Veteran to receive proper level of Comp
& Pension, Aid & Attendance
 Other Veteran income; Social Security
 20% are 70%+ SC : Decline VA-paid NH
MEDICAL FOSTER HOME
CAREGIVERS
MEDICAL FOSTER HOME CAREGIVERS
 Complete an application and
participate in an interview with the
Medical Foster Home Program
Coordinator and other staff as
needed.
 Be financially stable
 Be at least 21 years of age.
MEDICAL FOSTER HOME CAREGIVERS
cont.
Encouraged to:
 Complete a financial statement
 Provide results from a criminal
background check
 Provide at least four personal and
professional references
MEDICAL FOSTER HOME CAREGIVERS
cont.
 Physically able to provide the needed care,
have a written backup plan if they become
incapacitated including relief persons.
 Experience as a caregiver, formal or informal
 Psychosocial assessment of everyone involved
in the care of the Veteran
MEDICAL FOSTER HOME CAREGIVERS
cont.
 Able to communicate with the Home Based
Primary Care (HBPC)/SCI health care teams any
significant changes in the veterans’ normal
appearance, behavior or state of health.
 Be willing to accept, participate in and follow the
Veteran’s treatment plan.
CAREGIVER KNOWLEDGE, SKILLS, AND
EDUCATION
Medical Foster Home caregivers are required to
have the knowledge and skills in the following
areas:
 Provision of personal care specific to veterans’
level of functioning (Activities of Daily Living);
 Medication management;
 Crisis management and re-hospitalization
procedures.
 Provision of supportive and emotional care.
CAREGIVER KNOWLEDGE, SKILLS, AND
EDUCATION cont.
 Nutrition and proper food preparation,
distribution and storage.
 Activity and program planning.
 Applicable VA policies provided during MFH
evaluation and educational opportunities offered
by the VA.
 Protecting the Veteran’s privacy and
confidentiality.
 State and local laws and ordinances.
 Fire and safety procedures.
Continuing Education
 Will be obtained through appropriate channels, i.e.,
state/local programs.
 Documentation of the training completed by the MFH
caregivers will be maintained in the VA and the MFH
records.
 The HBPC/SCI/MFH programs will offer educational
sessions periodically.
Continuing Education
 Topics may include, but not limited to: cultural
diversity, ethics, HIPPA, infection control,
communication, dementia, personal boundaries and
conflicts of interest.
 HBPC/SCI team members will provide ongoing
education on the management of the individual
patient’s medical and social needs.
Finding a Caregiver
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Drive: Compassion + Devotion, not money
Able and enthused for daily care
Long-term commitment
Patient will get worse, not better
Job will get harder, not easier
Accept unannounced visits
Still interested?
THE MEDICAL FOSTER
HOME RESIDENT
Disabled Adults
 "Disabled person" is defined as any person who has a
physical or mental impairment that substantially
limits one or more major life activities, has a record of
such impairment, or is regarded as having such an
impairment.
 "Major life activities" are defined as functions such as
caring for one's self, performing manual tasks,
walking, seeing, hearing, speaking, breathing,
learning and working.
Who is a Candidate for MFH?
 Veteran with disabling condition
 Advanced chronic disease or terminal illness
 Needs assistance & supervision; no caregiver
 Unable to live independently due to functional,
cognitive or psychiatric impairment
 Meets nursing home criteria
 Meets HBPC criteria – interdisciplinary care
 Able to pay for MFH
Medical Foster Home Residents
 All are incapable of self preservation due to mental
status and/or functional status:
Mental status problems may be the result of dementia,
traumatic head injuries, neurological diseases, or
psychiatric disorders which include schizophrenia,
obsessive compulsive disorder, and bipolar disorder
Medical Foster Home Residents cont.
 All are chronically ill with multiple complex medical
problems
 All need primary medical care and care coordination
 All need medication---generally complex regimens
Medical Foster Home Residents cont.
 Virtually any patient that can be cared for in the home
by a biological family member can be cared for in a
medical foster home
 Careful matching of patient “type” and caregiver is a
necessity---and it may not be on target the first time.
Medical Foster Home Residents with
Medical Conditions
 Average age ---76
 Range---50-97
 Race---primarily Caucasian
 Number of major diagnoses---4
 Average diagnoses or medical problems---16
Medical Foster Home Residents with
Medical Conditions cont.
 Average number of medications--- 12
 Majority are NON-SERVICE Connected
 Limited income
 Very limited family support
Major Diagnoses
 Dementia in over 50%
 Heart disease
 Hypertension
 Diabetes
 Significant Degenerative Joint Disease/Osteoporosis
RECRUITMENT OF HOMES
 Referrals may come from the individuals
themselves or from other VA and non-VA
personnel.
 The prospective MFH caregiver may
informally discuss the potential use of their
home.
 An application for participation in the MFH
program must be made in writing by the
prospective caregiver and forwarded to the
MFH Coordinator.
RECRUITMENT OF HOMES cont.
 An initial assessment of the home to evaluate
the caregiver’s predictors for success: strong
interpersonal skills, good listening skills, and
problem solving skills is completed by the
medical foster home coordinator.
 If the recommendation is positive, a formal
inspection is scheduled. If negative, the
applicant will be notified in writing.
MEDICAL FOSTER HOMES - CRITERIA
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Be located, designed, equipped, and
maintained to ensure a home-like environment,
and to provide safe care and supervision of all
residents.
Be in a safe area as evidenced by acceptable
results by the police and sheriff reviews.
MEDICAL FOSTER HOMES - CRITERIA
cont.
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Caregiver must own or rent the home and the
location of the home shall be the caregiver’s
actual place of residence in compliance with VA
and State regulations if licensed.
The medical foster home household optimally
will include a married couple or a single
caregiver.
MEDICAL FOSTER HOMES - CRITERIA
cont.
 Meet all State, VA
and local licensure
requirements and
regulations,
including
construction, fire,
maintenance, and
sanitation
regulations
Initial and Annual Follow-up
Inspections
 Must be inspected by a VA
multidisciplinary team
which includes a Fire and
Safety Officer, Nurse,
MFH Coordinator,
Dietician and
Rehabilitation therapist.
MEDICAL FOSTER HOME
ENVIRONMENT
 Private or semi-private room
 24 hour supervision
 Variety of relationships
 Flexibility in daily routine
 Choice of homes
 Safeguards against abuse
 Signed agreement between MFH and Veteran
 Pets
SERVICES AND SUPPORT TO THE
MEDICAL FOSTER HOME
 Home Based Primary Care (HBPC)
 Mental Health Intensive Case Management
program (MHICM)
 SCI Home Care program
 Respite program
 HISA grants
 Pharmacy
 Prosthetics
 Hospice program
SERVICES AND SUPPORT TO THE
MEDICAL FOSTER HOME cont.
 Day Treatment Programs
 Recreational Activities
 Home Health Agencies
 Support groups for Veterans in the community
and at the VA
 Training
MEDICAL FOSTER HOMES - SAFETY
 Inspections by VA team and others in the
community as needed.
 Fire Extinguishers
 Emergency Exits
 Emergency Preparedness
 Fire Drills
MEDICAL FOSTER HOME - INFECTION
CONTROL
 TB testing/x-rays
 Avian Influenza/Regular “Flu” (recommended)
 Washing Hands
 Safe meal preparation
COORDINATOR WEARS MANY HATS
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Recruits medical foster homes
Inspects and approves medical foster homes
Process referrals of Veterans to MFH program
Match patient to foster home
Arrange trial visits if necessary
COORDINATOR WEARS MANY HATS
cont.
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Assist with Veteran’s application process for VA
pensions & Social Security
Coordinate VAH discharges & placement to MFH
Maintenance & support of placement
Conducts unannounced visits to MFH
Keeps statistics and completes reports as
requested.
Conducts quality assessments for Veterans, their
families and caregivers.
QUESTIONS?