INSPECTOR GENERAL SAYS VA NEEDS BETTER CARE FOR

BRAIN INJURIES -- Lack of VA / DoD co-ordination

a major concern.

The VA's OIG web site is here... http://www.va.gov/oig/

The latest report is titled:  Health Status of and Services for Operation Enduring Freedom/Operation Iraqi Freedom Veterans after Traumatic Brain Injury Rehabilitation

The VA does good work here, but some areas of concern are co-ordination between DoD and VA (Seamless Transition)...support for families...and case management.

Full IG report here... http://www.va.gov/oig/54/reports/VAOIG-05-01818-165.pdf

Report's Conclusions and Recommendations below:

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Conclusions

Health Status of TBI Patients Following Rehabilitation

As a group, the 52 patients interviewed for this review continued to suffer some degree of cognitive and behavioral impairment approximately 16 months after injury. Memory deficits, depression, anger, and social isolation were prominent findings. While most patients had achieved a substantial degree of recovery, approximately half remained considerably impaired.

Comparisons with Model Systems of Care

VA TBI patients had very similar outcomes when compared with a matched group of non-VA Model Systems program patients. However, we noted that this group of VA TBI patients, all of whom were on active duty at the time of injury, had a longer time from injury to entry into rehabilitation.

Case Management

Long-term case management efforts still need improvement. Brain injury causes major cognitive and behavioral problems with long-term consequences. The challenge of geographic isolation from VA facilities is frequently met through fee-basis arrangements. However, services are often very limited in the communities where injured veterans live, and multiple factors contribute to sub-optimal access to care. We found that for the 52 patients we interviewed, coordination of care varied significantly. Furthermore, numerous problems were associated with the transition from DoD to VA care. The large number of these patients still on active duty but primarily receiving their care from VA facilities presents a new challenge for VA and DoD. Improved coordination of care between VA and DoD for active duty patients is needed, and transmittal of appropriate medical records needs to be ensured.

Support for Families

Families need additional support in the care of TBI patients. We found that families often provide heroic support for injured service members, but they frequently do so with limited assistance. The patients and families we interviewed identified the following resource needs:

• Family support groups.
• Community-based rehabilitation for TBI.
• Sheltered workshops and employment opportunities.
• Improved information about TBI for patients and families, including those without access to the Internet.
• Further assistance in obtaining benefits from DoD and VA.
• Greater assistance in making the transition from hospital to home.

If VHA is to meet the needs of TBI patients, it should provide improved support for the family members and other caregivers so vital to patient well-being in the long-term. Consideration should be given these identified needs.

Recommendations

The Under Secretary for Health should:

A. Improve case management for TBI patients to ensure lifelong coordination of care.

B. Work with DoD to establish collaborative policies and procedures to ensure that TBI patients receive necessary continuing care, regardless of their active duty status, and that appropriate medical records are transmitted.

C. Develop new initiatives to support families caring for TBI patients, such as those identified by patients and family members we interviewed.

D. Work with DoD to ensure that rehabilitation for TBI patients is initiated when clinically indicated.

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Larry Scott

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