STATEMENT OF CHRISTA HOJLO, PH. D.
DIRECTOR, VA COMMUNITY LIVING CENTERS AND
STATE VETERANS HOME CLINICAL AND SURVEY OVERSIGHT
OFFICE OF GERIATRICS AND EXTENDED CARE, OFFICE OF PATIENT CARE SERVICES
VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

BEFORE THE SENATE COMMITTEE ON VETERANS' AFFAIRS
FIELD HEARING - TUPELO, MS

July 3, 2008

Good morning, Senator Wicker.  My name is Dr. Christa Hojlo, and I am the Director of the Department of Veterans Affairs (VA) Community Living Centers (formerly VA nursing homes) and State Veterans Homes Clinical and Survey Oversight.  First, I would like to thank Chairman Akaka and, you, Senator Wicker, for hosting this hearing.  I am honored to appear before you as a representative of the 13,000 Community Living Center employees serving our nation’s bravest and finest, and I am in awe of our beautiful surroundings.  We recognize and esteem the history made here at the Mississippi Methodist Senior Service facility on the grounds of the First United Methodist Church in Tupelo, Mississippi.  I am proud to report the Veterans Health Administration (VHA) is following the lead of these innovators by providing a dynamic array of services to veterans of all ages requiring care in VA Community Living Centers.

VA owns and operates 133 Community Living Centers from Puerto Rico to Hawaii with an average daily census of more than 11,000 veterans in Fiscal Year (FY) 2007.  These facilities range in size from 20 to 240 beds.  We serve approximately 49,000 veterans annually with a budget of approximately $2.7 billion and offer a dynamic array of services.  “Short stay” services are for veterans in need of rehabilitation or skilled post-hospital nursing, or for those awaiting placement in a board and care home for a period of less than 90 days, generally.  VA also offers “long stay” services for veterans with a disability rating of 70 percent or greater or who are in need of nursing home care for a service connected condition requiring lifelong care.  VA Community Living Centers also offer respite care to relieve family members who care for veterans at home and we offer hospice care in a kind and supportive environment so veterans may be with their loved ones and live fully until they die with dignity.

Through its Community Living Centers, VA provides care to veterans of all eras – World War II, Korea, Vietnam, the Gulf War, and Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF).  Some veterans have short-term needs and others require longer stays – whatever their specific situation, we are here to help.  We are sensitive to the fact that these different groups will have different expectations and clinical needs.  However, we are confident VA has the resources and the right strategy to address the interests of all veterans requiring care in these settings.

The term “nursing home” conveys certain impressions and ideas that do not reflect VA’s approach to care.  Informing a young, severely injured veteran that he or she will need to live in a nursing home can be extremely distressing because the term often invokes stereotypical images of being cared for in a large, institutionalized, and geriatric setting.  Consequently, we no longer use the term “nursing home” to refer to our facilities – rather, we refer to them as Community Living Centers.  This terminology more accurately conveys VA’s philosophy of care and represents more than a name change.

This change in nomenclature is important because it emphasizes that the veterans residing in these facilities are unique individuals who have basic rights to privacy and autonomy that must be respected.  VA’s policies have evolved to clearly reflect and encourage this transformation in the culture of care.  We are significantly improving work and care practices at existing VA facilities, and adjusting our designs for new centers as well.

Traditional nursing home designs centered on the needs of staff – the nurses’ station served as the central gathering place, and events are planned according to the staff’s calendar.  In contrast, VA’s approach is similar to the “Green House” or “Small House” model, first developed here in Tupelo.  We believe our residents should be able to live as independently as possible.  They decide when to have guests, when to eat, when to bathe, and when to sleep.  Nursing care takes place in the veteran’s bedroom.  Our residents also choose what they want to eat, and food is served as if at home or in a restaurant.  We respect the dignity of each of our veterans and try to simulate life as it might be in a private home. 

VA is committed to a veteran-centric model of care and is developing formal guidance for its Community Living Centers with input from both residents and field staff.  VA is the largest integrated health care system in the U.S. to adopt these principles, and we think there is even more we can do to provide a more personalized environment for our residents.  Last month, VA held a conference for nurse and physician leaders in New Orleans to discuss this cultural transformation and to emphasize care for a new generation of veterans.  A chairperson has been selected to oversee the national training program and the planning committee will meet later this month to discuss next steps.

We are expanding age-appropriate care models in several ways in response to the needs of our residents.  In some locations, we pair younger veterans with each other.  At other facilities, the populations reflect several generations.  Both models have their advantages.  In an age-specific cohort, we can meet specific needs of younger veterans, who are more likely to have young children and similar interests, such as, computer technology and electronics, that differ from the interests of older veterans.  In mixed-generation settings, our older residents can serve as parental surrogates for our young veterans.  Meanwhile, interaction with younger veterans can provide older veterans with an important connection and a renewed sense of purpose.  Intergenerational support is important for veterans of all ages.

Some of our facilities are geared specifically to younger veterans with cognitive deficits produced by the traumas of war, usually traumatic brain injury (TBI) or post traumatic stress disorder (PTSD).  For example, the Tuscaloosa Community Living Center has established a center and a TBI/PTSD program team for OEF/OIF veterans.  VA’s Community Living Center in Washington, D.C. has separate living areas for OEF/OIF veterans.  The National Defense Authorization Act for FY 2008 requires VA to provide age-appropriate nursing home care to veterans in need of such care for their service connected disability and for veterans with service connected disability rated at 70 percent or more.  To fulfill this mandate, VA is developing proposals for future modifications to the environment of care in our facilities to further the goal of deinstitutionalizing nursing home care.

While we realize we can never completely match the experience of living in one’s own home, VA is taking significant strides toward a more responsive and responsible model of care in a deinstitutionalized setting.  Thank you, Mr. Chairman, for the opportunity to appear before you today.