Paralyzed Veterans of America's Medical Services and Health Policy program puts boots on the ground year-round at Department of Veterans Affairs (VA) medical centers nationwide to ensure the proper standards of care. "Our department carries forward Paralyzed Veterans’ most important mission—to monitor quality of care provided for veterans when they come back from war," says Lana McKenzie, associate executive director of Medical Services and Health Policy.
A staff of full-time benefits advocates and medical clinicians—Paralyzed Veterans is the only veterans service organization with its own team of registered nurses and physicians—regularly visits VA's 24 spinal cord injury (SCI) centers, outpatient clinics and long-term care facilities. Site visits conducted by a doctor, nurse and service officer from the Veterans Benefits Department give patients an outlet for complaints and also highlight systemic issues, such as short staffing, nurse-patient ratios or lack of access to durable medical equipment.
Where problems exist, the team takes action to resolve them quickly, working with VA care providers and administrators. The result has been better decision making and more consistent treatment of SCI patients' special needs, such as annual physicals, follow-up care and quality prosthetics.
A recent success was VA’s decision to change the formula for calculating its nurse-patient ratio. Using data it had collected monthly over several years, Medical Services showed that the existing nurse-patient formula—which factored in all nursing personnel, including administrators, supervisors and managers who had no direct patient contact—was inequitable, and proposed a ratio that increased bedside nurse staffing. The new VA ratio is based on patient needs and the number of bedside nurses—an improvement that will positively affect care for veterans in spinal cord units.
Medical Services is also confronting a lack of long–term, inpatient SCI beds as the population of SCI veterans 85 years old and older grows, thanks to advances in medical treatment and care. In the next two years, the number of veterans 85 years and older in long-term-care facilities is expected to increase by more than 1.2 million. But with near-normal life expectancy comes other challenges for veterans and for the medical facilities that care for them.
"As people with spinal cord injuries live longer, they're going to need geriatric care," McKenzie says, noting that only 150 of the VA's 30,000 long-term-care beds are equipped for people with SCI.
To ensure that this dramatic rise does not lower standards, the Medical Services team is leading the campaign for more VA long-term-care facilities. The team is also expanding its assessment nationwide to state veterans homes and community nursing to gain a better understanding regarding the quality of care for the SCI individual. Other ongoing efforts include assisting with the development, design and organization VA’s SCI/D program, providing educational support to VA committees and offering guidance to the general public on caring for individuals with SCI/D.
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Lee Fleming is a writer based in Washington, DC, whose articles appear in national publications and on the Web.