Dr. Mary Beth Skupien ORH Director

In the Spring issue of ‘The Rural Connection’, we are highlighting National and local Geriatrics programs in the VA that enhance care for the rapidly growing elderly rural Veteran population. According to VHA data sources, 8% of enrolled rural Veterans are 85 or older and nearly half are over the age of 65. These numbers are quite large in comparison to the general U.S. population in which 2% of Americans are 85 or older and 13% are over the age of 65. Older adults are more likely to suffer from chronic conditions such as heart disease, diabetes, dementia and stroke. They also seek medical care and services associated with the aging process more often, so it is essential that the VA improve access to care for this population.

The VHA Office of Rural Health (ORH) is partnering with the VHA Geriatrics and Extended Care (GEC) Office and has funded several initiatives addressing geriatrics-related issues. ORH is supporting the expansion of the successful home based primary care (HBPC) program into rural areas, including 50 HBPC sites currently serving 22,000 rural Veterans. To address the barrier to care caused by a shortage of Geriatricians and rural providers with expertise and training in geriatrics, ORH is supporting the Geriatric Scholars program. This National VHA in-service education program is leading the way to nationwide quality improvements for geriatric care in rural Community-Based Outreach Clinics (CBOCs). Since the program began there have been 239 participants.

Transportation remains an important access to care issue for rural Veterans, especially for those who are older and/or disabled. Since 2009, ORH has funded numerous transportation initiatives throughout the country. For Fiscal Year (FY) 2012, ORH is providing $4.8 million to support transportation initiatives in nine different VA Service Networks (VISNs). In addition, ORH is providing $2 million to help expand the Veterans Transportation Service (VTS).

The goals of this new program are to improve coordination of transportation services, increase Veteran transportation options, and to utilize 21st Century technologies to improve the efficiency of existing transportation resources.

ORH also supports the expansion of home telehealth into rural areas by funding demonstration projects and equipment purchases. These telehealth initiatives target homebound Veterans with chronic conditions and those at risk for long term institutional care. The aim of these initiatives is to allow Veterans to remain at home while being monitored by a VA care coordinator. Along these lines, and because dementia is a significant cause of morbidity in the elderly population, ORH is supporting the VA Proactive Dementia Care Pilot program to rural areas. This program combines education of rural CBOC staff on how to screen for memory disorders; telehealth technology for extension of specialty care from a neuropsychologist; and coordination of provider activities to come up with a comprehensive management plan that can be implemented by patient aligned care teams (PACTs) in coordination with the Veteran and their family members.

Finally, we highlight an effort to support family members of rural Veterans who have suffered a stroke by disseminating a guidebook for caregivers. The guide was developed by VA researchers and is a companion to the Resources and Education for Stroke Caregivers Understanding Empowerment (RESCUE) website. These resources are intended to help family members become skilled caregivers for their loved ones as well as to help them cope with the daily challenges and stress of doing so.

The Office of Rural Health is committed to ensuring that the health care needs of elderly rural Veterans are met. With a multipronged approach of home health care, telehealth, chronic disease management, transportation and caregiving initiatives, the VHA is making great strides in their mission to ‘honor America’s Veterans by providing exemplary services that are both patient centered and evidence based.”