STATEMENT OF
THOMAS G. MCCLURE, L.C.S.W.
COORDINATOR, VA MEDICAL CARE FOSTER HOME PROGRAM
CENTRAL ARKANSAS VETERANS HEALTHCARE SYSTEM
LITTLE ROCK, ARKANSAS
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE

April 25, 2002

Mr. Chairman and members of the Committee:

My name is Tom McClure and I am a VA social worker at the Central Arkansas Veterans Healthcare System. I am honored to be here today because one of your staff, Kim Lipsky, heard me and a colleague present our Medical Care Foster Home Project at a recent national conference, and she thought you would be interested. We recently finished a pilot, funded by VA, and we are now disseminating our findings.

For 23 years I have been working in our Home Based Primary Care Program. I saw firsthand how hard veterans worked to stay in their own homes even though they had severe chronic illnesses and disabilities, unsuitable housing, and poor social supports. I often witnessed how difficult it was for elderly spouses to continue to care for their very disabled husbands. Time and time again I observed the unwillingness of veterans and their families to consider placement in a nursing home.

We wanted to try to find ways for these patients to continue to stay in the community and still get the care they needed. A few times I helped our patients make informal community arrangements to live in the home of a hired caretaker. These situations worked out well for the veterans. The Home-Based Primary Care ( HBPC) team managed the medical care. Then we heard about our Central Office's "New Clinical Initiative Funding." We asked for and were given the resources to develop Medical Care Foster Homes for our veterans-- $95,000 for each of 2 years. This money paid my salary so I could develop foster homes full time. It also paid for my half time assistant, travel costs and cell phone costs. We set about to recruit caring families and individuals in the communities served by our large HBPC program.

Now, 2 years later, we now have 35 foster homes and 45 patients. Our outside funding has ended, but the Medical Center chose to continue at the same level of funding. Eight of our Foster Care patients are 100 percent service connected; some of them came directly from a community nursing home to our foster home at their own expense.

Here is how our program works. When I recruit a foster home, I assess their motivation, attitude, life experience, and I explain the general needs of our disabled veterans. I check their references and do a criminal background check. Our safety engineer inspects the home environment. If everything checks out, we approve the home and can begin to match the home with patients who are interested in family living. We involve any family or friends of the veteran in the process of selecting a foster home. I encourage them to visit a few homes. I serve as an intermediary between the veteran and the foster home sponsors in agreeing on the monthly fee. This fee ranges from $1000 to $1800 per month depending on the care needs of the veteran. For this fee the veteran gets a private room, personal care, 24-hour supervision, meals, laundry, and activities. This is a permanent home. We do not uproot these veterans when they become terminally ill and place them in a nursing home. They remain in the foster home. It is understood that the VA will provide medications, supplies, and health care. All the veteran's needs are met.

The veterans pay for their Medical Foster Care with no funding from VA. They use their Social Security, private pensions, and VA pensions or service-connected disability compensation. Most have spending money in reserve. The veterans who qualify for non-service-connected pensions can have their pensions increased to cover the costs of the Medical Foster Care. We have a liaison in the Little Rock VA Regional Office that assists us in processing claims in a timely manner, but sometimes it does take several months.

Once in Medical Foster Care, the patients are visited regularly by the HBPC team members, who conduct an interdisciplinary geriatric assessment, develop a treatment plan, provide medications and medical equipment, and educate the foster family in the care of the veteran. Because of the close partnership between our Foster Care Program and HBPC, we safeguard against abuse.

So far we have recruited our Medical Care Foster Homes from persons in the community who are experienced in caring for the elderly, either former health care workers or those with experience caring for family members. Even though the income is important to foster home sponsors, we feel the most important factor is that the program instills meaning and purpose to their lives. This is why we can recruit good people. Also we help our Foster Home Sponsors. They have 24-hour access to us. We also offer respite 2-4 times a year so they can rest and reduce stress levels.

We believe Medical Foster Care/ HBPC is humane care and affordable for VA and the Veteran. At our facility, with a census of 45 patients in foster care, the VA direct care costs are $29 per day for the HBPC portion of the care, plus $8 per day for the Foster Home Program, for a total of $37 per day.

The Central Arkansas Veterans Healthcare System has formed a partnership with the Medical Foster Care Program and the HBPC Program, permitting us to provide this unique care environment. Many states have adult foster care. But this program is just for veterans and VA healthcare providers are actively involved in caring for the patients and overseeing the homes. The most important feature of this program is that it improves the quality of life for our frail, disabled veterans in a family atmosphere. We take sick, depressed veterans from our wards, place them in a family environment and they become grandfather, uncles, and father role models.

Here at Little Rock, we are at capacity for the number of homes and patients can be managed with existing staff. HBPC's census of 180 is now 25 percent Foster Care patients and growing. With this program in its infancy, we are unable at this time to predict the limits of its growth.

I believe VA Medical Centers could develop Medical Care Foster Homes in conjunction with existing Home Based Primary Care Programs. It is not easy work, but it is important and gratifying work that would give our aging veterans a true alternative to institutional care.

This concludes my statement. I will be happy to respond to the Committee's questions.