Bonnie G. Garnette, MSW, LCSW-BACSProgram Coordinator

WHAT IS A MEDICAL FOSTER HOME?

MEDICAL FOSTER HOMEA 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. Merging of adult foster home with VA

Home-Based 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 1999Problem: Veterans in HBPC decline, not safe

to live alone, refuse NHOpposing ethical principlesUnsafe at home, or force out of home?Solution – find a willing caregiver, meet

medical care needs through HBPCPilot 2004 – in Tampa, Florida and San Juan

Puerto Rico VA Hospitals

Goals of MFHAlternative to nursing home for certain

VeteransMeet increasing demand for LTC through

care in non-institutional setting Give Veterans option to remain in family

settingImprove quality of life for Veterans Veteran in safe and therapeutic environmentFacilitate most appropriate use of VA and

community resourcesProvide longitudinal care in a home to

include end-of-life and preventative care

Benefits of MFHVA offers an option to nursing home care, in

a less restrictive environmentVeteran can choose a home environmentMFH less costly than nursing homeCost savings to VA for 70%+ SCBenefits to caregiversBenefits to community

Economics of MFHWho pays for MFH ?MFH rates are negotiated according to level

of care and Veteran’s ability to payVeteran pays for MFHVA works with Veteran to receive proper

level of Comp & Pension, Aid & Attendance Other Veteran income; Social Security20% are 70%+ SC : Decline VA-paid NH

MEDICAL FOSTER HOME CAREGIVERS

MEDICAL FOSTER HOME CAREGIVERSComplete an application and participate in an interview with the Medical Foster Home Program Coordinator and other staff as needed.

Be financially stableBe at least 21 years of age.

MEDICAL FOSTER HOME CAREGIVERS cont.Encouraged to:Complete a financial statementProvide results from a criminal background check

Provide at least four personal and professional references

MEDICAL FOSTER HOME CAREGIVERScont.

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 tohave the knowledge and skills in the followingareas: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 EducationWill 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 EducationTopics 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 CaregiverDrive: Compassion + Devotion, not moneyAble and enthused for daily careLong-term commitmentPatient will get worse, not betterJob will get harder, not easierAccept 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 conditionAdvanced chronic disease or terminal illnessNeeds assistance & supervision; no caregiverUnable to live independently due to functional,

cognitive or psychiatric impairmentMeets nursing home criteriaMeets HBPC criteria – interdisciplinary careAble to pay for MFH

Medical Foster Home ResidentsAll 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 ConditionsAverage 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 DiagnosesDementia in over 50%Heart diseaseHypertensionDiabetesSignificant Degenerative Joint

Disease/Osteoporosis

RECRUITMENT OF HOMESReferrals 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 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.

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 InspectionsMust be inspected by

a VA multidisciplinary team which includes a Fire and Safety Officer, Nurse,

MFH Coordinator, Dietician and Rehabilitation

therapist.

MEDICAL FOSTER HOME ENVIRONMENTPrivate or semi-private room 24 hour supervisionVariety of relationshipsFlexibility in daily routineChoice of homesSafeguards against abuseSigned agreement between MFH and

VeteranPets

SERVICES AND SUPPORT TO THE MEDICAL FOSTER HOME

Home Based Primary Care (HBPC)Mental Health Intensive Case

Management program (MHICM)SCI Home Care programRespite programHISA grantsPharmacyProstheticsHospice program

SERVICES AND SUPPORT TO THE MEDICAL FOSTER HOME cont.

Day Treatment ProgramsRecreational ActivitiesHome Health AgenciesSupport groups for Veterans in the

community and at the VATraining

MEDICAL FOSTER HOMES - SAFETYInspections 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 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. 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.