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					             Blind Rehabilitation Service
             Department of Veterans Affairs



             Provision of Blind and Vision
             Rehabilitation Care for Veterans
             and Active-duty Personnel with
             Visual Impairment

Gale Watson, CLVT, Acting National Director
Washington, D.C.
Vision Rehabilitation Program Manager,
Atlanta VA Medical Center
          The VA Blind Rehabilitation
          program supports blind and low
          vision veterans and active duty
          service members in regaining their
          independence and quality of life to
          enable their successful integration
          into family and community life.


Blind Rehabilitation Service
Department of Veterans Affairs
                         BRS Program Components

 • VACO BRS National Program Office
 • 5 National Program Consultants (field-based)
 • 105 full-time Visual Impairment Services Team (VIST)
   Coordinators, additional 51 part-time VIST Coordinators
 • 11 new full-time VIST positions to be deployed by end FY2008
 • 10 Inpatient Blind Rehabilitation Centers
 • 38 Blind Rehab Outpatient Specialists (BROS); 35 new BROS
   positions recently approved (PL 109-461 sec 207 and 208)
 • Inpatient/Outpatient Computer Access Training (CAT)
 • 2 Visual Impairment Services Outpatient Rehab Programs
   Lebanon, PA & W. Haven, CT
 • 55 new Continuum of Care clinics, a 3-tiered level of vision
   rehab care provided
Blind Rehabilitation Service
Department of Veterans Affairs
                           VIST: Visual Impairment
                               Services Team
           A team of professionals who ensure that
           blinded veterans are identified, evaluated,
           and provided health and rehabilitation
           services to maximize adjustment to sight
           loss. Representatives may include but are
           not limited to: social work, ophthalmology,
           optometry, prosthetics, primary care,
           vocational rehabilitation, nursing, audiology,
           physical medicine and rehabilitation,
           Veterans Benefits Administration, and
           blinded veterans’ consumer organizations.


Blind Rehabilitation Service
Department of Veterans Affairs
                            Visual Impairment
                        Services Team Coordinator
             The VIST Coordinator is a case manager who has major
             responsibility for the coordination of services for visually
             impaired veterans, service members, and their families.
             The VIST Coordinator is often the entry point into the
             continuum of care for visually impaired veterans.
             Duties include providing and/or arranging for the
             provision of appropriate rehabilitation services and
             devices (referrals to BRC, BROS, Continuum of Care
             clinics and/or community-based services).
             Other duties include identifying new cases of blindness
             and severe visual impairment, providing professional
             counseling, arranging VIST Reviews, and conducting
             educational programs relating to VIST and blindness.
Blind Rehabilitation Service
Department of Veterans Affairs
                                          Maintaining Increased
                                         Demand for VIST Services

                                  Number of Legally Blind Veterans on VIST Rolls

      48,000

      45,000

      42,000

      39,000

      36,000

      33,000

      30,000

      27,000
                    FY96        FY97        FY98        FY99       FY00   FY01   FY02   FY03   FY04   FY05   FY06   FY07


     Source: VIST annual reports; BR 5.0 FY 2006 & 2007 annual report




Blind Rehabilitation Service
Department of Veterans Affairs
                 Blind Rehabilitation Centers
                           10 Centers Nationwide


Comprehensive, interdisciplinary, residential inpatient blind
rehabilitation services: 1,897 discharged in FY2006, 1,899
discharged in FY2007.
241 inpatient BRC beds: Occupancy rate = 79.5% in FY2006,
77.2% in FY2007.
Five specialized areas of training: orientation and mobility,
living skills, manual skills, visual skills and CAT.
Veterans also receive specialized healthcare, wellness
education, and adjustment counseling support.
The average Length of Stay is 5 weeks: FY2006 = 35.7 days,
FY2007 = 35.6 days.
All Blind Rehab Centers are CARF accredited.
                      Blind Rehabilitation Centers
                                 10 Centers Nationwide




Blind Rehabilitation Service
Department of Veterans Affairs
                                        BRC Inpatient Bed Capacity



                                                           FY 96   CURRENT
   Total Authorized Beds                                  228      241
   Comprehensive Inpatient Beds                           204      195
   CAT Program Beds                                        20       46
       Source: BRC Annual Reports, FY2007; OCC Rate: KLF




Blind Rehabilitation Service
Department of Veterans Affairs
                                            Maintaining Inpatient BRC
                                                Discharge Levels

                                                   BRC Total Annual Discharges

     2,100


     1,900


     1,700


     1,500


     1,300
                   FY96        FY97        FY98        FY99   FY00   FY01   FY02   FY03   FY04   FY05   FY06   FY07

     Source: BRC annual reports; KLF AMIS national report




Blind Rehabilitation Service
Department of Veterans Affairs
                                        Decreasing Total Veterans on
                                             BRC Waiting List

                                        Veterans on BRC Waiting List FY04 - FY07

   3000


   2500


   2000


   1500


   1000
             Oct03    Jan04   April04   July04   Oct05   Jan05   April05   July05   Oct05   Jan06   April06   July06   Oct06   Jan07   April07   July07


     Source: BRC annual reports




Blind Rehabilitation Service
Department of Veterans Affairs
                                           Average Waiting Time:
                                        Regular Inpatient Program

                          Avg. Waiting Time: BRC Regular Program (weeks)

           30




           20




           10
                        FY02             FY03   FY04   FY05     FY06       FY07


           Source: BRC annual reports




Blind Rehabilitation Service
Department of Veterans Affairs
                                Average Waiting Time:
                                Computer Access Training (CAT)
                                Inpatient Program

                              Avg. Waiting Time: BRC CAT Program (weeks)

            40



            30



            20



            10
                        FY02             FY03   FY04    FY05     FY06      FY07


            Source: BRC annual reports




Blind Rehabilitation Service
Department of Veterans Affairs
                                           BRC Profile:
                             Most Commonly Reported
                             Eye Diseases & Conditions
                                 Williams & De l’Aune, 2007 (VA Research Study C-2669-R)




                              FY ‘97 to FY ‘06
                                    (N=9,097)
                                        Age-Related Mac. Deg.        40.1 %
                                        Glaucoma                     23.4 %
                                        Diabetic Retinopathy         16.8 %
                                        Macular (non ARM.)            7.7 %
                                        Retinitis Pigmentosa          5.5 %
                                        Combat-related Trauma         1.4 %




Blind Rehabilitation Service
Department of Veterans Affairs
                                        BRC Profile:
                         Medical / Health Conditions
                                 Williams & De l’Aune, 2007 (VA Research Study C-2669-R)



                                   FY ‘97 to FY ‘06
                                     (N=10,630)
                                          Cardiac                40.3 %
                                          Neuropathy             16.6 %
                                          Diabetes (inject meds) 16.2 %
                                          Pulmonary              15.5 %
                                          Neurological           13.6 %
                                          Diabetes (oral meds) 12.9 %
                                          Cognitive               8.8 %
                                          Renal                   4.8 %
                                          Severe Hearing Loss 18.8 %
                                          Average # Co-Morbids 1.6
                                           (19.3% of veterans in BRCs have 3 or
                                           more Co-Morbids)


Blind Rehabilitation Service
Department of Veterans Affairs
                                                              BRC Profile:
                                                            Demographics
                                 Williams & De l’Aune, 2007 (VA Research Study C-2669-R)



                                  FY ‘97 to FY ‘06
                                     (N=11,231)
                                         Age                      69.7 yrs
                                         Race (Caucasian)         74.7 %
                                         Race (AA or Black)       15.8 %
                                         Race (Latino/Hispanic)    8.5 %
                                         Gender (Male)            95.3 %
                                         No HS Grad               11.5 %
                                         HS Grad                  25.4 %
                                         > High School            62.1 %
                                         < $20K yr. Income        35.4 %




Blind Rehabilitation Service
Department of Veterans Affairs
                                      BRC Profile:
                   Duration of Vision Impairment
                                 Williams & De l’Aune, 2007 (VA Research Study C-2669-R)




                                    FY ‘97 to FY ‘06
                                    (N= 10,275)


                                      Less than 1 year              5.2%
                                      1 to 3 yrs.                  33.2%
                                      More than 3 yrs.             61.6%




Blind Rehabilitation Service
Department of Veterans Affairs
                      VISOR: Visual Impairment
                  Services Outpatient Rehabilitation
                              Program

        The VISOR program is a short stay (~9-day)
        outpatient program designed to meet the
        rehabilitation needs of high functioning partially
        sighted veterans. It is staffed with Blind
        Rehabilitation Specialists. Veterans must be
        capable of self-care as the program uses HOPTEL
        beds without nursing support. The 2 VISOR
        programs graduated 46 Patients in FY2007.




Blind Rehabilitation Service
Department of Veterans Affairs
                          BROS: Blind Rehabilitation
                            Outpatient Specialist
                          Program Implemented in 1996
                         38 current positions Nationwide
                      21 new positions to be hired in FY2008
                   14 additional positions to be hired in FY2009

     Local blind rehabilitation assessment and training designed to:
     - decrease the time needed for inpatient rehabilitation
     - obviate the need for the inpatient program, or
     - meet the needs of those veterans who are unable to attend BRC.

     Public Law 109-461, Sec. 207 & 208 was successfully passed into
     law December, 2006. This legislation increases the number of
     outpatient specialists at VA medical centers by placing newly
     created Blind Rehabilitation Outpatient Specialists (BROS)
     positions at 35 additional VAMCs within 30 months of passage.

Blind Rehabilitation Service
Department of Veterans Affairs
                         Additional BROS positions

           Public Law 109 - 461, signed into law December,
           2006
           •35 additional BROS positions over 30 months of
           passage
           •Priority based on veteran population data
           (ARC 369.4)
           •Located where no BROS positions currently exist
           This will essentially double the number of BROS,
           currently staffed with 38 positions nationwide

Blind Rehabilitation Service
Department of Veterans Affairs
                                             Increasing Demand

                                                     Veterans Served by BROS

        4,500


        3,500


        2,500


        1,500


          500
                    FY97         FY98        FY99        FY00   FY01   FY02   FY03   FY04   FY05   FY06   FY07


       Source: BROS annual report; BRS FY2007 capacity report




Blind Rehabilitation Service
Department of Veterans Affairs
                             National Program
                               Consultants

                                 5 Positions Nationwide


              National Program Consultants provide support,
              review, and evaluation of field based Blind
              Rehabilitation Services. They are actively
              involved in program development and staff
              training.




Blind Rehabilitation Service
Department of Veterans Affairs
                             Continuum of Care
                       For Visually Impaired Veterans


            Announced by then-VA Secretary Nicholson on
            January 25, 2007.
            VA will make approximately $50 million available
            during the next three years to establish a
            comprehensive nationwide rehabilitation system
            for veterans and active duty personnel with
            visual impairments.



Blind Rehabilitation Service
Department of Veterans Affairs
                         Continuum of Care
                   For Visually Impaired Veterans
   This continuum of services is designed to ensure early intervention
   for patients whose vision loss results from progressive diseases
   like age-related macular degeneration, diabetic retinopathy and
   glaucoma.

   In addition, expands capacity to serve care for a growing number of
   veterans returning from service in Iraq and Afghanistan with
   wounds and trauma that result in blindness and visual impairment.

   VHA is the first national healthcare system to completely and
   seamlessly integrate rehabilitation services for patients with visual
   impairments into its health benefits, ensuring that they receive the
   finest medical and rehabilitation care, as well as cutting-edge
   assistive technology.

Blind Rehabilitation Service
Department of Veterans Affairs
                                 Continuum of Care:
                                  Implementation
      Each Veterans Integrated Service Network (region) will implement
      a plan to provide eye care to veterans with visual impairments
      ranging from low vision to total blindness.
      Basic low-vision services will be available at all VA eye clinics.
      Every network will offer intermediate and advanced low vision
      rehabilitation services including assessment, training and a full
      spectrum of optical devices and electronic visual devices
      Each VISN will provide outpatient blind rehabilitation
      Inpatient blind rehabilitation centers will continue to provide
      intensive and comprehensive inpatient blind rehabilitation
      Goal is early intervention to maximize independence and reduce
      dependence on families and communities.
Blind Rehabilitation Service
Department of Veterans Affairs
                                 Continuum of Care:
                                  Implementation
      Three levels of service have been funded:
          Intermediate Low Vision Care
          Advanced Ambulatory Low Vision Care
          Outpatient Hoptel Blind Rehabilitation
      Start-up costs are available in FY2008, recurring costs will be
      provided in FY2009 and again FY2010.
      Each VISN is required to implement a plan for the provision of
      the services consistent with the Continuum of Care
      recommendations, which are mandated for patients with low
      vision and blindness.


Blind Rehabilitation Service
Department of Veterans Affairs
                                  Continuum of Care:
                             Continuum of Care
                             Clinical Training Components

                         LVT/     ADL/
               Optical   Visual   Comm.   O&M   Adjust   Audiology   Manual   General   CAT
               Devices   Skills                                      Skills   Medical

       Basic   +         +
Intermediate   ++        ++       +
   Advanced    +++ +++ +                  +     +        +
  Outpatient
Blind Rehab    +++ +++ ++                 ++    ++       ++                             ++
   Inpatient
Blind Rehab    +++ +++ +++ +++ +++ +++ +++ +++ +++

Blind Rehabilitation Service
Department of Veterans Affairs
BRS Program Components




               Blind Rehabilitation Service
               Department of Veterans Affairs
                            BRS Services and OEF/OIF

    All Blind Rehabilitation Service program components actively support
        veterans and active duty service members of OIF/OEF.

    Visual Impairment Service Team (VIST) Coordinators
    • Involvement with Military Treatment Facilities through liaisons
    • Case management in support of Polytrauma Rehabilitation programs
    • Ongoing case management at local medical centers

    Blind Rehabilitation Outpatient Specialists (BROS)
    • BROS assigned to Walter Reed Army Medical Center and Bethesda
    • BROS assigned to all Polytrauma Rehabilitation Centers
    • Treat patients in homes, communities, and local VAMCs



Blind Rehabilitation Service
Department of Veterans Affairs
                            BRS Services and OEF/OIF

           Blind Rehabilitation Centers
           • Provide comprehensive, individualized,
             inpatient blind rehabilitation.
           • Full clinical support services.
           • Continuity of care at admission through
             discharge.

           71 OIF/OEF veterans or service members admitted
             into inpatient BRC programs as of May 23, 2008
             (86 total episodes of inpatient BRC care).


Blind Rehabilitation Service
Department of Veterans Affairs
                            BRS Services and OEF/OIF

    Outreach Services
    • Bi-monthly conference calls for veterans & service
      members, their families, and professionals who
      support them.
    • Educate veterans to benefits and services available
      to them.
    • Follow up minutes/newsletter.
    • Support service member development of peer
      relationships.
    Individual support services by blinded veteran staff.


Blind Rehabilitation Service
Department of Veterans Affairs
               Workforce Planning

Blind Rehabilitation Service is facing a
massive attrition of staff due to “Boomer”
retirement at the same time that we are
dramatically expanding our programs. In
the next five years, we must recruit and
train approximately 60-80% of our current
staff.
                         Technical Career Field Program
         • A total of 50 post-graduate
           internships have been funded to
           train and place new BRS
           professionals in a 3-year period
           (2007-2009)
         • Interns receive 2-year salary,
           $20,000 for travel and training and
           $20,000 relocation funds if internship
           is completed and intern takes a VHA
           BRS position other than the training
           site
Blind Rehabilitation Service
Department of Veterans Affairs
                                 Performance Monitors

            • Patient Outcomes: Average functional change in
              self-reported level of task difficulty from
              admission to discharge in patients attending a
              BRC
            • Patient Satisfaction
            • Performance Measures Monitored in Program
              Office
                 –   Utilization Rates
                 –   Occupancy Rates in Blind Rehab Centers
                 –   Waiting Times
                 –   Average Length of Stay
                 –   Maintaining Capacity within BRS system


Blind Rehabilitation Service
Department of Veterans Affairs
                                 New National Database
             Benefits of the Blind Rehabilitation Service national database

             • Complies with HealtheVet Architecture (online patient self-monitor
             of personal healthcare, prescription refills, personal health journal)
             • Complies with 508 regulations
             • Accessible web based application, via a web browser
             • Easy access to care
             • Seamless continuum of care
             • Simplified data entry
             • Better identification and tracking of patients
             • Consolidates data
             • Enables system driven Waitlist tracking and reporting capabilities
             • Enables users to receive comprehensive views of a patient’s Blind
             Rehab Services across institutions nationally
             • Facilitates data tracking and auditing capabilities
             • Improves accountability
             • Provides Data Standardization which improves and provides
             consolidated data reporting
Blind Rehabilitation Service
Department of Veterans Affairs
    Blind Rehabilitation Service
    Department of Veterans Affairs




Thank You For Your Attention!


      VA Blind Rehabilitation Central Office Team
       Gale Watson, MEd, CLVT, Acting Director
    Wanda Washington, Program Analyst
       Michael Williams, PhD, Data Manager

				
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