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The purpose of the meeting was to discuss coordination of veterans’ services with the Cambridge Health Alliance (CHA). |
April 30, 2008Committee Report #2
In City Council June 23, 2008 The Veterans Committee held a public meeting on Wednesday, April 30, 2008 at one o’clock and two minutes p.m. in the Sullivan Chamber. The purpose of the meeting was to discuss coordination of veterans’ services with the Cambridge Health Alliance (CHA). Present at the meeting were Councillor Craig Kelley, Chair of the Committee, Councillor David Maher, Robert Stevens, Director of Veterans’ Services, Michael Buckley, Special Assistant to the CEO of the CHA, Dr. Ruth Barron, Director, Adult Outpatient Psychiatry, CHA, Janet M. Dunphy, RN, Case Manager and Social Worker, CHA and Deputy City Clerk Donna P. Lopez. Councillor Kelley convened the meeting and stated the purpose. This meeting is to try to get a better understanding of what services are available, HIPA, the number of veterans being served now and what the city can do to serve the veterans better. Mr. Buckley stated that the CHA is interested in helping veterans. He mentioned a meeting held on March 22, 2005 by the Veterans Committee on this subject. The CHA complies with the HIPA regulations, which limit sharing information about patients. He had some ideas about marketing brochures and other ways to share information and he would find a way to link Ms. Dunphy and Mr. Stevens together to refer patients to Veterans Services just as they refer patients to other services. There are no plans to negatively impact veterans care; the quality of care for veterans will remain. Patients are not asked if they are a veteran so it is a guess how many patients are veterans. In the rehab area patients may share information about whether they are a veteran. It is difficult to record this information due to the fact that a patient could be a senior citizen who is also a veteran. Over a nine month period, from July 1, 2008 to march 30, 2008, the CHA treated a total of 176 patients for 307 visits; this includes both hospital and ambulatory care and is a very small percentage of CHA’s overall visits. Councillor Kelley questioned whether patients are asked if they are a veteran in the emergency room. Mr. Buckley responded that patients are only asked this question in the Psychiatry Department. Ms. Dunphy added that if a patient has Medicare the veteran question is asked. Mr. Stevens commented that statistically it would be good to track veterans if the question could be asked of all patients. Councillor Kelley commented that the major focus aimed at by Veterans’ Services Department is the indigent. Mr. Stevens stated that any information on veterans is helpful. He would like information on veterans on Mass. Health or the Health Safety Network because his office could provide financial assistance medical services. If a patient does not have health insurance the CHA assists patients in filing a Mass. Health application. The Veterans Services picks up the health cost exclusive of Mass. Health. If the indigent veteran were identified and has Mass. Health he would like this information passed on to his office. He suggested distributing a veteran’s brochure outlining services provided when an intake is conducted or ask the veteran to sign a release form and refer to his office. Besides medical assistance, Mr. Stevens’ office can assist eligible veterans with housing allowance, heating allowance and so forth. In a response to a question by Councillor Kelley Mr. Stevens stated that coverage by Mass. Health indicates low income while Health Safety Network is free care. Mr. Buckley stated that the CHA offers financial counselor assistance. Ms. Dunphy stated that if a patient has financial issues they are referred to a financial counselor. A veterans services brochure could be given out and referral to Veterans Services Department. Mr. Stevens stated that there were two issues:
Mr. Buckley asked Mr. Stevens what other benefits could be received by a veteran. Mr. Stevens responded non service connected pension, disabled veteran or person 65 years or older are eligible for $1,000 per month. World War II veterans have disability ratings from the VA; they are assisted to receive additional disability. There is no income guideline for service connected disability. In fact, as any veteran ages and their disabilities get worse, their disability pay may be increased if the worsening physical condition is properly documented. Mr. Stevens’ office has a 90% success rate in increasing such benefits. There are eight different categories for eligibility into the VA health care system. A discussion ensued about health care at CHA versus VA. If veterans were served by the VA, it might save the CHA money, depending on type of reimbursement CHA receives for services. Mr. Buckley stated that the CHA maintains quality care for all patients. Dr. Barron outlined her survey of veterans. Telephone survey of intake patients. The question is asked if patient is a veteran. Since 2005 there have been 258 calls made. The impact of military service on psychiatry could be on the service member, children or spouse. Of the 258 calls 76% (197) were seen in psychiatry; 50% (19) did not result in visit and 4% (11) were treated in the trauma clinic. Councillor Kelley asked where the intake calls took place. Dr. Barron responded the calls were in the out-patient or referred by PCP or patient. In a portion of the survey there is no connection to military service or direct link to the veteran. There was a 63% in the affirmative that the patient did service in the military, not necessarily the US military. Mr. Stevens’ services only cover people who served in the US military. There were five people who were dishonorable discharged. Dr. Barron asked Mr. Stevens if these five people were covered by the Veterans’ Services. Mr. Stevens responded in the negative, but the Veterans’ Services Department could assist them in having their discharge upgraded. Dr. Barron asked Mr. Stevens if veteran can receive service at the VA. Mr. Stevens stated that a veteran may opt not to go to VA. Veterans seeking mental health service will increase in the future. CHA staff stated that CHA has expertise in treating trauma, but not in treating combat related trauma, though they would be interested in setting that sort of treatment up if there were enough interest. Mr. Stevens noted that the VA has specific programs aimed at PTSD and asked if the CHA had any such programs. He asked Dr. Barron if there was a collaboration developed between the CHA and the Mr. Mel Tapper, State Veterans Administration from the meeting held in 2005. Dr. Barron stated that she would be pleased to connect with Mr. Tapper. Councillor Maher asked Mr. Stevens how many residents are in Afghanistan or Iraq. Mr. Stevens stated that he did not know. Upon discharge the armed services notifies the state of Massachusetts. Since 911 less than 100 residents have served in Iraq. Councillor Maher asked if outreach is done to veterans. Mr. Stevens responded in the affirmative if a DD214 is issued. Councillor Kelley asked why the DD214 would say Cambridge. Mr. Stevens responded if Cambridge is the home of record or the mailing address of the veteran after the tour of duty to include getting off of active duty after an active tour in the National Guard or Reserves. If a person’s DD214 has the home of record as being Cambridge, it is still possible that the veteran may not return to Cambridge or that a veteran could come to Cambridge even though the DD214 may have the home of record as being someplace else. Mr. Stevens would not know about this latter group. Councillor Maher asked if there are support groups. Mr. Stevens stated that if a person is a member of the reserve or National Guard there are family support groups. Councillor Kelley stated that veterans are falling through the system because the veteran question is not asked. Mr. Stevens stated that it would be helpful if the CHA system could ask patients if they were a veteran or a surviving spouse, who may be 100% eligible for their deceased veteran spouse’s benefits, then give out a brochure that outlines the services available. He asked that the veteran who is being assisted by the financial counselor be apprised of the financial and medical benefits, to include out of pocket prescription costs, provided by the Veterans’ Services. This clientele, he felt, are not aware of these benefits. Medicare Part B and D and insurance premiums are paid. Is surviving spouse eligible if veteran is not alive asked Councillor Kelley? Mr. Stevens stated that the surviving spouse if eligible if they have not remarried. Councillor Maher asked if there is an objection to this happening at the CHA. Mr. Buckley stated that this is happening in the Psychiatry Department and that it seemed like more of an administrative issue and that CHA would be happy to put up posters, fliers, etc. Councillor Kelley clarified that if a patient has insurance the question of whether the patient is a veteran is only being asked in the Psychiatry Department. Councillor Maher asked is there a systematic change at CHA to prevent asking the question about veterans. Dr. Barron stated that there are many clinics at the CHA; it is a much bigger problem than the CHA. A public service announcement has been done by the Veterans’ Services Department stated Mr. Stevens. Massachusetts is the only state that is offering this service. Dr. Barron asked Mr. Stevens to provide posters to the CHA. Mr. Stevens asked if the veteran question could be added to the CHA data base. Councillor Maher stated that once the information is gathered intake needs to know to make the referral to the Veterans’ Services. A great place to start this may be at the financial counselor. Who pays for the posters/flyer/brochures, asked Councillor Maher. The city would have to pay stated Mr. Stevens, though the State has generic outreach information he passes out. This information is in the city-wide newsletter and the City View, but it is not placed in the Tax Facts brochure. Notices were sent to the Senior Centers and the Veterans Services Department picked up three new clients. Councillor Maher suggested a mailing to the Marsh Post and the Mt. Auburn VFW to capture the veterans. Mr. Steven informed the committee that he has made presentations at these locations and the Senior Center and various homeless providers, but only got three new clients. Still, he said, three new clients are three new clients. A lot of veterans do not know that Mr. Stevens can act as their agent, as various other advocacy groups can. Also, many Post members do not live in Cambridge, though and his services are only available for Cambridge residents, residents of other towns must access services through their respective Veterans’ Services Department. Councillor Kelley stated that the starting point would be for the CHA to ask the question regarding veterans and point to the benefits available. Ms. Dunphy asked if prescriptions are covered. Mr. Stevens outlined the income level and the asset guideline as follows:
There are asset guidelines that help define eligibility, but real estate does not count. Ms. Dunphy questioned the health care for the homeless. Mr. Stevens responded that $167 stipend per month is provided if homeless and medical is provided. Mr. Stevens pointed out that the key to increasing disability pay is having good medical records. Councillor Maher asked how many veterans there are in Cambridge. There are 2,000 veterans in Cambridge according to the census stated Mr. Stevens, though he expressed concern that the census data may not be very accurate. There is also information in the assessor’s database concerning surviving spouse abatements. There are 92 veterans that utilize veterans services; an increase of 20-22% in the last two years due to the cable TV advertisement. Clients come and go, so the number served over the course of a year exceeds 100. Councillor Kelley asked if the census number captures the number of veterans. Mr. Stevens stated that if people respond to the census. It however does not capture the homeless. In 2005 a veteran form went out with the city census. The World War II veterans are decreasing at a rate of 1,000-2,000 per day. Councillor Maher informed Mr. Stevens if there is not adequate money in the budget to let the City Council know. He suggested that placing on the form at intake the question “Are you a vet?” Cambridge residents would you like to receive information from Veterans’ Services on the benefits available to you – contact Veterans’ Services Department. Mr. Stevens noted that Cambridge-focused brochure may not be relevant for CHA since so many of their patients are not Cambridge residents. Councillor Kelley stated that Korean War veterans are in the hospital for a lengthy stay. Could visitations be developed for these veterans? Mr. Buckley stated that the volunteer services director at CHA will be consulted to formalize this procedure. CHA will get back to Councillor Kelley on this matter. There may not be enough veterans in CHA to warrant setting up such a support service. Mr. Stevens commented on HIPA and stated that a religious preference is asked at the hospital; why not veteran status. Dr. Barron asked Mr. Stevens for an e-mail so that the clinicians and support staff would be updated on veteran’s benefits. Mr. Stevens responded that he would provide Dr. Barron with the information. At the conclusion of the meeting Councillor Kelley outlined the follow up:
Councillor Kelley thanked those present for their attendance. The meeting adjourned at two o’clock and thirty-five minutes p. m. For the Committee,
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