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Date: JUN 1, 2004
From: Deputy Under Secretary for Health for Operations and Management (10N) Subj: Blind Rehabilitation Waiting List for Computer Access Training
To: VISN Directors (10N1-23) Medical Center Directors

1. Waiting times to access all of the ten (10) Blind Rehabilitation Centers need to be reduced. One of the training programs offered at the Blind Rehabilitation Centers is Computer Access Training. Attached is a summary of a Computer Access Training initiative to reduce waiting times. 2. The Rehabilitation Strategic Healthcare Group (SHG) and Prosthetics and Sensory Aids Service SHG are working collaboratively to provide funds and contractors to teach Computer Access Training to veterans' in their home'area, where feasible. We believe this to be a cost effective alternative, which will reduce waiting, increase access, and benefit blinded veterans. 3. Blind Rehabilitation Centers must review the existing Computer Access Training waiting lists. Patients whose computer training could be provided locally should be referred to the assigned Visual Impairment Services Team (VIST) Coordinator. VIST Coordinators will arrange for Computer Access Training in the veteran's community. 4. Questions concerning this initiative should be directed to Lucille B. Beck, Ph.D., Chief Consultant, Rehabilitation SHG. Dr. Beck can be reached on 202-745-8578.

/) ~ ,1IA£..~~'f- Laura J. Miller

A FORM MAR 1989 2105

Computer Access Training for Blinded Veterans Issue: Long waiting times to enter the Computer Access Training (CAT) programs and the comprehensive Blind Rehabilitation program at the ten (10) Blind Rehabilitation Centers are major issues for VHA. Average waiting time for the CAT Program is 31 weeks with 674 veterans on the waiting list. Average waiting time to enter the comprehensive program is 28-30 weeks. Several key factors have highlighted the need to address the provision of services for blinded veterans in local communities, where feasible. ● In FY 2003, a Government Performance Review Act (GPRA) study of prosthetics and sensory aids identified several barriers to computer access training. Most notable were long waiting times followed by patient reports that travel to an inpatient program for an extended length of stay was not feasible. VHA's Action Plan, accepted by the Deputy Secretary's Senior Management Council in 2003, in response to the GPRA study, initiated efforts to outsource CAT programs in local communities and support funding of local training. ● A recent study conducted by the Atlanta VA Rehabilitation Research & Development Center examining the utilization of VA blind rehabilitation found that 58% of eligible, legally blind veterans who had not participated in VA blind rehab services indicated that a primary barrier for them was a reluctance to travel to a distant inpatient BRC program. Eighty-nine percent of the legally blind workload consists of Patient Priority Groups 1-6. ● Blinded Veterans Association (BV A) has identified waiting times and the lack of local services to veterans as barriers to care in their annual resolutions for several years. In response to the resolutions, VHA has committed to exploring options for the provision of local services. ● GAO is currently studying waiting times and waiting lists for Blind Rehabilitation. The study appears to have expanded into a comprehensive review of the Blind Rehabilitation Services provided by VHA. It is expected that long waiting times will be one of the major issues and will include a recommendation to utilize local services closer to the veterans' homes. ● The cost of one bed-day of care in a BRC is approximately $800-$1,000. Typically CAT training programs are no less than two (2) weeks in length. The cost of 40 hours of local CAT training is approximately $2,000. The cost of the veteran's computer equipment irrespective of where training is provided is the same. Presently, the VERA model bases resource allocation for blind rehabilitation services on an inpatient stay at a Blind Rehabilitation Center. Rehabilitation SHG is currently working with VHA Office of Finance to develop a model which recognizes the provision of specialized blind rehabilitation services across the continuum of care. The Plan ● Beginning June 2003, VISTs, and National Blind Rehabilitation Consultants were asked to identify and review local community and private sources and determine which could provide quality training opportunities. Currently, the Blind Rehabilitation

Centers (BRC) were asked to triage the waiting list and determine which patients might be viable candidates for local CAT service. ● The two categories under review for local services are: (1) Patients who have not received an admission offer date to a BRC; and (2) Patients who are medically able and have local services available in their communities. ● Patients whose needs are best met in the blind centers, those patients who live in remote areas where no local services are available and those whose medical needs require training at the BRC will stay on the waiting list for CAT training. Beds designated as CAT beds will continue to be utilized for those patients unable to be served in the community. ● The Blind Rehabilitation Service Satisfaction survey will be used to measure patient satisfaction with the local services and data will be collected and analyzed by the Atlanta Research Group. ● A Blind Rehabilitation Workgroup developed national standards for the Computer Access Training (CAT) Program and participated on the VHA Prosthetic Clinical Management Program (PCMP) Clinical Practice Recommendations for the Prescription of Computers and Peripheral Devices for Blind and Visually-Impaired Veterans. The PCMP workgroup is also developing additional guidelines and competencies for local support services to blinded veterans. ● The provision of local services is consistent with V ANHA Strategic Goals and Objectives in improving access, convenience, and timeliness of VA health care services. Providing CAT services in the community will greatly decrease the number of patients on the waiting list and reduce waiting time for those patients needing to access a blind center. ● The attached memo was distributed by PSAS to the VISN Prosthetic Representatives and Blind Rehabilitation field staff.

~ blind rehab.doc

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