1. Conclusions We have continually stressed that, due to research limitations, a true control population was not attainable; however, the resulting comparison patient population does provide valuable information about the treatment process when compared with the study patient population. All the findings presented in this interim report on the pilot program point to a few major conclusions: o The study and comparison patient populations are more seriously o The VA patients that accept and complete extended halfway house treatment have made significant advances in all employment measures and in reducing their alcohol and drug use as well as other measures. o Although the comparison patients were assessed as having less serious problems at both admission and follow-up than the study patients, the overall extent of improvement was greater for the study patients. • The results of the "Block Cluster Analysis" show the utility of multivariate analysis for identifying individuals who may be more or less suitable for various types of treatment, and they yield unique characterizations of patients which may partially explain the success or failure of treatment modalities. o The data suggests that with the receipt of additional follow-up reports a more suitable control patient population can be developed.. This would involve comparing study patients who completed their halfway house program with three other groups of patients. Patients who did not want to enter a halfway house. Preliminary data, some of which is not addressed in this report, 37-524 0-84-30 Addendum IV CIRCULAR 10-83- 115 9. Guidelines for Selection for Post-Hospital Referral It should be emphasized that this program is limited to out-placement of eligible veterans who have recently completed detoxification or other hospital level treatment. The program is not intended for use as an emergency boarding house, nor as a way-station for veterans headed for domiciliary placement, nor for treatment prior to hospitalization or rehospitalization. Technical (clinical) guidance, patient selection, and. associated coordination will be provided by the Office of the Chief, ADI?, or DDTP, at the contracting VA medical center. When there is no ADTP or DDTP at the VA facility, these functions will be provided by the physician who has major responsibility for the VA treatment of such cases. a. Placement in Residential Facility: (1) As specified above, all such out-placements should be capable of self-preservation. In an emergency situation, the patient should have sufficient capacity to recognize physical danger, sufficient judgment to recognize when such danger requires immediate egress from a group residence, sufficient capacity to follow a prescribed route of egress, and sufficient physical mobility to accomplish such egress. (2) Patients who, for various reasons, need a slower integration into the community, perhaps requiring a low-skilled job and some help finding a room with cooking privileges. (3) Alcohol or drug abusing veterans who, because of health problems, may find readjustment to "street life" tough going, and who may need additional time and support in order to be self-supportive. (4) The alcohol or drug dependent veteran who has an unsatisfactory home environment may need more time to stabilize the changes made in the inpatient unit, before living autonomously or returning home. (5) The semi-stable individual who has considerable ego strength and some environmental support, but due to a crisis, needs a brief stay in a residential setting and requires a therapeutic milieu. b. Placement in Outpatient Treatment Facility: This option applies to veterans who have available residential support and/or employment in a location sufficiently distant from a VA treatment facility, that participation in a VA outpatient treatment program is not feasible: Such but-placements should reflect, sufficient prior collaborative planning with the non-VA program as to assure continuity of treatment activities and general endorsement of VA treatment goals. ADDENDUM V PREPARED STATEMENT OF JACK J. DACK, LEGISLATIVE CHAIRMAN, NATIONAL ASSOCIATION OF STATE VETERANS HOMES POSITION OF NATIONAL ASSOCIATION OF STATE VETERANS HOMES IN OPPOSITION FOR THE NEED FOR LEGISLATION TO PROVIDE A TECHNICAL AMENDMENT, SECTION 8, SUBSECTION (b) OF SECTION 5035, TITLE 38, OF THE UNITED STATES CODE WHICH WOULD: "REQUIRE THE ADMINISTRATOR OF THE VETERANS ADMINISTRATION TO DEVELOP CRITERIA PURSUANT TO WHICH APPLICATIONS FOR GRANTS FOR CONSTRUCTION, REMODELING, EXPANSION, OR S-2269 SENATE VETERANS AFFAIRS COMMITTEE NATIONAL ASSOCIATION OF STATE VETERANS HOMES S-2269 VETERANS ADMINISTRATION HEALTH-CARE PROGRAM IMPROVEMENT ACT OF 1984 4-2-84 Mr. Chairman, Distinguished Members of the Senate Veterans Affairs Committee, the National Association of State Veterans Homes appreciates this privilege to express opposition for the need for Legislation to provide a technical Amendment, Section 8, Subsection (b) of Section 5035, Title 38, of the United States Code, which would: "Require the Administrator of the Veterans Adminis- expansion, or alterations of State Veterans Home Facilities can be awarded on a basis other than The State Veterans Home Program has grown from eleven homes in eleven states in 1888 to presently fifty-two homes in thirty-four states. Nursing Home Care is provided in forty homes, Domiciliary Care in thirty-nine homes, and Hospital Care in six homes. These Homes presently have over 17,000 beds; and, in the Fiscal Year 1983, provided more than 4.3 million days of care. The State Veterans Home Program is an acknowledged, cost-effective alternative to providing long-term health services in Veterans Administration facilities. The State Home Construction Grant Program began with the passage of PL 88-450, on August 19, 1964, which authorized Nursing Home Care. In addition to setting a per diem rate of $3.50 for State Nursing Home Care, the Act authorized a five-year program, supported by an appropriation of $5 million per year for Grants to states for construction of Nursing Home Care Facilities. The Veterans Administration could participate in such Grants up to 50 per cent of the cost of construction. Subsequent Legislation which significantly changed the Construction Grant program is as follows: a) 1969, PL 91-178: Expanded Grants for States for assistance in re- for Veterans. b) 1973, PL 93-82: Changed the participation rates from 50 per cent c) 1977, PL 95-62: Redefined construction to mean new Domiciliary and Nursing Home buildings and expansion, remodeling and altera tion of existing buildings for the provision of Domiciliary Nursing Home Care or Hospital Care in State Homes and the provision of initial equipment to furnish such buildings. This Act changed the Veteran occupancy requirement in State Veterans This Act also changed the amount that any one state may receive in any Fiscal Year to one-third of the amount appropriated in such Fiscal Year. d) 1979, PL 96-151: Removed the $15 million limitation for authorized amounts for Construction Grants. e) 1980, PL 96-330: Removed the legal limitation of two and one-half beds per 1,000 Veteran population in a state and left to the Veterans Administration Administrator to prescribe the number of beds required to provide adequate Nursing Home Care to Veterans residing in each Regulations have established a ceiling of four beds per 1,000 Veterans with justification required if construction would result state. |