Defense, Veterans Affairs Departments to Coordinate on Patient Care

By Fred W. Baker III
American Forces Press Service

Oct. 31, 2007 - The departments of Defense and Veterans Affairs have partnered to put in place 10 federal recovery coordinators charged with managing the care of severely injured servicemembers and their families for as long as a lifetime. Officials from the two departments today signed an agreement outlining the role of the coordinators. These are the first positions of their kind in the military health care system and were put into place in response to recommendations from servicemembers, families and by the President's Commission on Care for America's Returning Wounded Warriors.

"This agreement will help ensure our nation's wounded warriors and their families receive the care they need and deserve at the right time, right place, and by the right person across the continuum from recovery through to their reintegration into their communities," said Michael L. Dominguez, principal deputy undersecretary of defense for personnel and readiness, in a news release.

VA will hire the coordinators and hopes to have them on board by January. They will be assigned to either Walter Reed Army Medical Center here; the National Naval Medical Center, in Bethesda, Md.; Brooke Army Medical Center, at Fort Sam Houston, Texas; and Naval Medical Center San Diego. The coordinators are charged with managing all the needs of severely injured servicemembers and their families as the troops move through the recovery and rehabilitation process and return to their communities.

The coordinators will work with only the most seriously injured servicemembers, including those with major amputations, burns, severe traumatic brain injury, post traumatic stress disorder, spinal cord injury, severe sight or hearing loss, or severe multiple injuries.

The coordinators are expected to carry a case load of about 30 patients each, officials said. Coordinators will meet with the servicemembers and families within days of their admission into the hospital and begin developing an individual recovery plan, said Dr. Lynda Davis, deputy assistant secretary of the Navy for military personnel. She is the Defense Department's lead official for the reform of wounded warrior care, specializing in case management.

"A plan will be developed for them that is patient-centered, family-centered, comprehensive, (and) which will put together all of the resources from the federal, state, and local government and private sectors in one place," Davis said.

The coordinators will act as a hub connecting the servicemembers and families to resources. She said military and family members reported sometimes being confused and overwhelmed by the multitude of support services available.

"(The servicemember) won't have to go looking through a stack of 100 business cards and try to remember who to call and when. It will all be there in one place. And it will change as their goals and healing changes," Davis said.

Recovery coordinators will help with all types of services, medical or otherwise. Coordination could include ensuring that families have travel orders and housing arrangements when they arrive at the hospital to be with the servicemember. Or it could include helping to find a home through a community volunteer organization for family pets while a family is at the hospital, Davis said.

"There is a variety of needs that we find don't have anything to do with medical care, and there are a lot of people who want to help. It's just making sure that they are appropriately connected to the family in the right way and at the right time," Davis said.

Also, Davis said, families complained they were often lost in the gaps of transitioning from one stage of care to the other, such as when patients change hospitals for more specialized care, leave the service and transition to veteran status, or when they return to their communities and start to reshape their lives. Recovery coordinators will predict those transition points and help prepare families so there are no gaps in care or benefits, she said.

Coordinating care for the veterans could last a lifetime, Davis said. "(Coordinators) say goodbye when that veteran says, 'I don't need you any more,'" Davis said.

Kristin Day, the chief consultant with VA's newly established Care Management and Social Work Service, said the coordinators will have the clout and connections to work out any problems with the system that servicemembers and families face.

In May, the VA stood up an Operation Enduring Freedom/Operation Iraqi Freedom case management program and hired 105 transition patient advocates. They are stationed at local VA centers and will also help in the transition of servicemembers to those services. But, federal recovery coordinators will help all servicemembers regardless of whether they choose VA facilities after their separation to provide their continued care, Day said.

The VA may hire more coordinators later, depending on the workload, she said. "We're taking a learning approach to developing this program. This is a new approach to care. It goes beyond health care and assists the person with all of their life needs," Day said. "During the first six months, we're going to be doing extensive evaluation to make sure we are meeting our customers' needs and that we are providing the services as they need them."