Michelle Karkheck Nicola, LISW-S Jamie Kuhne, LISW-S Department of Veterans Affairs Columbus, Ohio

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1 Michelle Karkheck Nicola, LISW-S Jamie Kuhne, LISW-S Department of Veterans Affairs Columbus, Ohio

2 Objectives Identify specific issues that aging Veterans of different eras experience. Identify services available at the VA to support aging Veterans. Understand conditions for which Veterans may be more vulnerable than the civilian population as they age. Our Background Questions- half way and end

3 World War II 12/7/41-12/31/46 Age late 80 s 90 s now Undiagnosed PTSD (called shell shock) Difficulty asking for help Large amount of hearing loss- Service Con Prisoner of War issues- cold injury, GI, heart disease, stroke, dental problems, anxiety, dysthymicpresumptive conditions

4 Exposure to Ionizing radiation linked with leukemia, cancers, multiple myeloma, lymphomas Many veterans signed away their rights to file claims with the VA in order to be discharged. They were never told this was no longer valid Catastrophic Disability- due to ADL dependency PTSD symptoms resurfacing due to dementia

5 Korean War July 27, 1953 (VA recognizes Korean War era through 1955) Often Called The Forgotten War Police Action versus War Armistice versus clear victory VA estimates 5.7 million Vets served Cultural Depictions

6 Cold Injuries Skin Cancer in frost bite scars Arthritis Lack of sensation Ionizating Radiation Related to Nuclear Weapons testing Cancers Noise

7 PTSD Depression Anxiety Ikin study of Australian Korean War vets Brooks study of Korean war vets versus other era vets and mental health

8 8/5/64-5/7/75 or in country service 2/28/61-8/5/64 Retirement age (ages 60-70) PTSD, agent orange, substance abuse- very sick for their age Difficult time engaging in VA care- unwelcome welcome home; anger toward government

9 Diseases linked to agent orange exposure continue to grow Current list includes: peripheral neuropathy, leukemias, type 2 diabetes, Hodgkin s, ischemic heart dis, multiple myeloma, non-hodgkins Lymphoma, Parkinson s, prostate cancer, respiratory cancers and soft tissue sarcoma

11 VA estimates in 2014, 71,000 LGB active duty and reservists 1 million LGB Vets 2.9% women, 0.6% men on active duty estimated lesbian/gay Estimated that 20% of Transgender individuals are Veterans, versus 10% of General population are Vets Estimated that 134,000 Vets are Transgender and 15,000 service members are Transgender

12 Will have served during Don t Ask, Don t Tell era History of discrimination, stigma Higher incidence of Trauma, including MST, than other Vets Importance of Advance Directives All LGBT Vets have: higher smoking rates, more suicide attempts, more STIs

13 ... At my direction, the working group will start with the presumption that transgender persons can serve openly without adverse impact on military effectiveness and readiness, unless and except where objective, practical impediments are identified. Second, I am directing that decision authority in all administrative discharges for those diagnosed with gender dysphoria or who identify themselves as transgender be elevated to Under Secretary Carson, who will make determinations on all potential separations. As I've said before, we must ensure that everyone who's able and willing to serve has the full and equal opportunity to do so, and we must treat all our people with the dignity and respect they deserve. Going forward, the Department of Defense must and will continue to improve how we do both. Our military's future strength depends on it

14 Ask assessment questions in a sensitive manner Are you in a relationship? versus Are you married? Do you have a wife? Do ask about sexual history For transgender individuals, screenings still needed for biological organs FTM: breast exams, pap smears MTF: prostate exams

15 AKA invisible veteran Growing population- currently 8% of veteran population Expected to increase to 15% by 2035 Massive changes to the provision of VA healthcare for women & role of women in mil WWI role of women changed as physical exam requirement was implemented

16 WWI possessed jobs as nurses, clerks, phone operators, and administrative jobs in D.C. WWII roles were expanded (aviation, communications, intelligence, pilots) - WACs, WAVES, WASPs After WWII recruitment of women halted until 1948 when they became a permanent part of the military

17 However, women restricted to 2% of the military population until 1967 Korea was time of significant impact-women nurses were crucial in Korea as only 3% of the men wounded died due to their care 1990 s crucial time for women in the military as over 40,000 women deployed in support of Persian Gulf.

18 WWII women formally recognized as veterans in the 1970 s-80 s In the 1980 s, many women still unaware of their access to VA benefits, access was reduced, and incomplete The 1990 s Congress pushed inclusion of sexual trauma in PTSD treatment, and the creation of Women s program Office

19 Your female client may have served but is not aware she s a vet and able to pursue VA healthcare Unidentified trauma issues

20 Amyotrophic Lateral Sclerosis (ALS) / Lou Gehrig s Disease-progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. May lead to complete paralysis Occurs approximately twice as frequently among Veterans than the general population Service Connected Condition with 90 days of continuous service

21 Advance Care planning is critical- considering such topics as: Vent care Communication devices Artificial hydration and nutrition Equipment needs Pressure Ulcers

22 Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body s immune system is directed against the central nervous system (CNS), which is made up of the brain, spinal cord and optic nerves. (Definition from National MS Society) Also higher incidence among Veterans Several varieties, and the course of the disease can vary greatly Can be service connected if symptoms start while in military or within 7 years of discharge

23 Future Planning important Unpredictability of the disease can be a struggle May be cognitive changes over time Equipment, Home Adaptation Paralyzed Veterans of America (PVA) provides advocacy for this and other Spinal Cord Injuries and Disorders

24 Traumatic Brian Injury linked with higher incidence of dementia; 60% more likely Issues further complicated with amputations and PTSD Veterans with diagnosis of TBI develop dementia 2 years earlier than those without Early onset dementia will be more common in younger vets due to repeated head injuries

25 Entering geriatrics services at a younger age Case management is crucial TBI s can be undetected, leading vet to be labelled difficult or non compliant Grief/loss suffering from disease that does not equate to their life cycle stage

27 Veterans Health Administration (VHA) provides comprehensive health care to eligible vets, including a wide range of Geriatrics services Health Care Eligibility- complex, factors may include: type of discharge, service connection status, income, functional status, length of service Direct questions re: eligibility/ enrollment to VA Eligibility; at Columbus: Charles (Skip) Turner

28 Service Connected Non Service Connected Non Service Connected Pension With Aid and Attendance Catastrophically Disabled Veterans OEF/OIF/OND Veterans (special 5 year eligibility)

29 Palliative Care Clinic- interdisciplinary team (MD, RN, MSW, Rd, Chaplain); helps manage symptoms; plan goals of care Geriatric Evaluation- interdisciplinary team (Geriatrician, RN, MSW, PT/OT); provides advice for a plan of treatment Spinal Cord Injury Clinic- interdisciplinary team (neurologist, physiatrist, PT, Rn, MSW) provides comprehensive exam and case mngt

30 Home Based Primary Care (HBPC): Brings primary care interdisciplinary team into the home, for homebound Veterans. Home Telehealth (HT): Utilizes technology to augment case management of chronically ill Vets, via phone/ cell phone

31 Medical Foster Home (MFH): Private caregiver opens up home to up to 3 Veterans, as alternative to nursing home placement. Vet private pays. VA provides oversight. Community Residential Care Home (CRC): Lower level of care than MFH. Must be independent with ADLs, need support for IADLs/ supervision. Vet private pays. VA provides oversight.

32 Hospice- comfort care in home for veterans near the end of life; utilizes community agencies Home Health Aide- personal care assistance in the home via community agencies Adult Day Health Care- attendance at community agencies to provide supervision, medical monitoring and caregiver relief

33 Respite- caregiver break achieved through day services, home care, or inpatient VA hospital. Able to receive up to 30 days per year Community Nursing Home- VA paid nursing home care for veterans who are highly service connected. VA staff visit NH s to assure quality of care Skilled care- arranges for nursing and therapy in the home via a community agency.

34 Locations- Medical centers in Cleveland, Cincinnati, Dayton, Chillicothe Columbus area- outpatient only Ambulatory Care Center Community Based Clinics around Columbus: Marion, Grove City, Newark, and Zanesville Implications for central Ohio vets

36 Alzheimer s Society. (2014). Traumatic brain injury linked to risk of dementia in Forces veterans. Retrieved from p?newsid=2074 Brooks, MS, & Fulton, L. (2010). Evidence of poorer lifecourse mental health outcomes among veterans of the Korean War cohort. Aging & Mental Health. 14(2), Carter, Ash. (2015). Secretary of Defense on DOD Transgender Policy. NR Retrieved from

37 Federal Benefits for Veterans, Dependents & Survivors. Department of Veterans Affairs. National Center for Transgender Equality. Military & Veterans. Retrieved from National Center for Veterans Analysis and Statistics. (2011). America s Women Veterans Military Service History and VA Benefit Utilization Statistics. Department of Veterans Affairs. Retrieved from _Womens_Report_3_2_12_v_7.pdf

38 Under Secretary for Health s Information Letter. (2014). Guidance regarding the provision of health care for lesbian, gay and bisexual veterans. Retrieved from sp?pub_id=3013 VHA Directive (2013). Providing health care for transgender and intersex veterans.

WOMEN VETERANS BOBBI SIMMS VETERANS HEALTH ADMINISTRATION

WOMEN VETERANS BOBBI SIMMS VETERANS HEALTH ADMINISTRATION WOMEN VETERANS BOBBI SIMMS Background/Quick Facts 1.8 million living Veterans Fastest growing subpopulation of Veterans women Approximately 300,000 receive care in the Department of Veterans Affairs (VA)