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Homemaker/Home Health Aide

Reprinted from PN August 2010

H/HHA covers personal care and related support services that enable frail or disabled veterans to live at home.

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Paralyzed Veterans of America (PVA) monitors the quality of healthcare for our members and other veterans at each VA facility nationwide. Frequently, this monitoring in the field leads to identification of an issue that affects those we serve in more than one locality or more than one veteran.

Recently, this was the case when a PVA National Service Officer (NSO) reported a patient’s care through the Homemaker/Home Health Aide (H/HHA) program was going to be terminated. The veteran’s local VA had determined it was spending an exorbitant amount through this program and, at the direction of senior management, was ordered to reduce expenses in this area. Unfortunately, this led some overzealous individuals to decide that across-the-board cuts in care would be the best way to manage the budget.

All enrolled veterans are authorized H/HHA when medically necessary as part of a comprehensive array of in-home services. H/HHA covers personal care and related support services that enable frail or disabled veterans to live at home.

Only trained personnel who have successfully completed a competency evaluation and are employed by a home health agency may provide these services, under the general supervision of a registered nurse and prescribed by a VA primary care provider (VHA Handbook 1140.6 5[b], July 21, 2006).

H/HHA services may include assistance with instrumental activities of daily living (IADLs) such as light housekeeping necessary to maintain a safe and sanitary environment in areas used by the individual, laundering for the patient, meal preparation, grocery shopping, escorting the person to necessary appointments, and ensuring patient safety.

They may also include assistance with activities of daily living (ADLs) such as bathing, toileting, dressing, eating, exercising, or other activities to maintain safety and well-being for the patient.

H/HHA services may not be used for medical care such as bowel care, catheterization, IV administration, wound dressing, or other skilled care that should be provided by a clinical professional. VA has a separate program for this type of care referred to as “Purchased Skilled Home Health Care.”

H/HHA services must be provided to enrolled veterans needing nursing-home care. This means an interdisciplinary team has made a clinical judgment that the veteran would, in the absence of home and community-based care services, need nursing-home care (VHA Handbook 1140.6 7[b], July 21, 2006).

For veterans to qualify, the interdisciplinary team must determine they have the following clinical conditions:

(1) Three or more ADL dependencies

(2) Significant cognitive impairment

(3) Requires H/HHA services adjunct to community hospice services

(4) Has two ADL dependencies and two or more of the following conditions:

- Dependency in three or more IADLs

- Has been recently discharged from a nursing facility or has an upcoming nursing-home discharge plan contingent on receipt of these services

- Is 75 or older

- Has had three or more hospitalizations in the past year, or 12 or more outpatient or emergency room visits in the past year

- Has been diagnosed with clinical depression

- Lives alone in the community

If a veteran does not meet the criteria above, services may still be provided, but the team must clearly document the need in the patient’s record.

H/HHA services will be provided without regard to the patient’s receipt of Aid and Attendance benefits. Priority is given to patients who need the care for a service-connected condition or who have a service-connected disability rating of 50% or more.

If you are approved for H/HHA services, VA must use a certified pro­vider. VA will attempt to honor your personal preference as long as the agency is certified and in good standing with state licensing agencies.

Each person in the program must have his/her need for service reviewed every six months for the first year and annually thereafter. This must consist of a review of pertinent VA clinical documentation to substantiate the continued clinical need for services.

VA cannot reduce or terminate a patient’s care unless he/she no longer requires the assistance previously provided. This is where the issue arose with the veteran cited earlier. The local VA attempted to terminate care without conducting the appropriate clinical review.

Once PVA was alerted to the problem, we contacted the CBO for the Veterans Health Administration (VHA) for assistance. They confirmed the attempted elimination of care was inappropriate. We also discovered the local VA attempted to reduce or eliminate care for 27 other veterans at the same time.

Our timely intervention led to the continuation of care for all these patients and changes to that facility’s review process that are in compliance with VHA’s standing policy manuals (i.e., VHA Handbook 1140.6 7[b], July 21, 2006). VA staff personally called each patient and provided a letter of reassurance that these individuals will continue to receive their prescribed care. In addition, VHA’s Geriatrics Service will update its national policy handbook to prevent future inappropriate reductions or terminations of H/HHA services.

If you need assistance applying for H/HHA services or receive them and have been told your care will be reduced or eliminated, contact your local PVA national service officer for assistance

Contact: PVA Veterans Benefits Department, 800-424-8200.

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Homemaker/Home Health Aide

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