Battle Creek VA Medical Center(269) 966-5600 ext. 35303(269) 223-5303
Home Based Primary Care
1
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
2
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: __________________
3
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
4
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.
5
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.
6
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.
7
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.
8
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 [email protected].
9
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.
10
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.
11
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
12
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.
13
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.
14
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.
15
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
16
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.
17
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.
18
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
19
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
20
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:
21
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.
22
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.
23
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.
24
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.
25
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.
26
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)
27
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.
28
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.
29
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/
30
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.
31
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.
32
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!
34
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
Top Related