WEBINAR: Veteran's Affairs Mobile Adult Day Health Care Program (May 5, 2016)

has begun good afternoon everyone let's go ahead and begin our webinar welcome to the webinar today on the US Department of Veteran Affairs mobile adult health care program facilitated by the National Alzheimer's and dementia Resource Center which consists of our team at RTI international I'm series schumann with the Resource Center and I will be moderating our webinar this afternoon the purpose of these webinars is to provide helpful current and applicable information for 80 s SP and a diosss grant projects and others in the aging Network please note the webinar today is being recorded and the PowerPoint presentation will be sent soon after the webinar we will allow time for questions through the webinar chat feature at the conclusion of the presentation if you have a question during or after the presentation please enter your question into the chat feature of the webinar at this time I'd like to turn it over to Aaron long from the administration on aging administration for community living to provide a brief welcome hi everyone I would like to thank you for taking the time out of your day to learn about the veteran's administrations mobile dake de program I want to thank karen massey and karen elico for spending their time with us to help us learn about this valuable resource we look forward to hearing what you have to say and with that I will just pass it back to theory thanks so much Aaron today as Aaron mentioned we'll hear from Karen Massey and Karen elico Karen Massey is the chief of strategic and transformational initiatives for geriatrics and extended care in the VA central office she has 36 years of working in the VHA including direct patient care medical care cost recovery and the decision support system she's based in her home office in New Jersey where her family includes three geriatric dogs a weimaraner her best friend a Labrador and a wobbly 15 year old toothless mostly blind and deaf mini dachshund who is appropriately named diva Karen elico is a registered nurse in an expanded role who works in the golden memory dementia clinic she created designed and implemented the mobile adult day health care program that serves veterans with memory safety strength and recreational activities at the veteran's service organization locations in Chester Delaware and montgomery counties in Pennsylvania she is also a member of the Alzheimer's Association International Society to advanced Alzheimer's research and treatment Karen and Karen I will turn things over to you you can get started as soon as your slides thank you very much this is Karen Massey and I want to thank you so much for this opportunity to talk about the mobile veteran program which is a mobile adult day health care program the program began in canandaigua as part of our innovative t21 initiative and karen elico has expanded that model to coatesville very very successfully and she will be presenting the information now about the program so Karen thank you Karen and thank you for having us today to share our program hello and welcome to the webinar presentation on our mobile veterans program we would like to begin by acknowledging all the veterans participating in this webinar thank you for serving our country we appreciate you we are here at the VA to serve you now the kotel VA Medical Center sends a team a VA care clinicians to five local American legions and or veterans of foreign we're poor post out in the community our program occurs at one site per day from ten a.m. until 2pm coatesville has a team of four who provide care of these sites with a maximum enrollment of 20 veterans per site the approach is cost-effective and self-sustaining for future years and helps the elderly and injured veterans to benefit from structured care and an informal environment this community care based mobile health strategy reduces distance barriers improves access to care and compliance with care and provide support to family caregivers as well as empowering veterans to remain independent and home-based so we're going to go to our next slide and explain one veteran story this is a 67 year old male United States Air Force Vietnam veteran with a medical history of bipolar disorder dementia nicotine and cocaine use chronic obstructive pulmonary disease decreased hearing and vision and two recent suicide attempts in February in March he was referred to our program by his VA primary care provider through his mental health intensive case care manager she had contacted me on the phone and asked me to do a review of his chart and see about his appropriateness for the program and after a review uh I thought that the program would really benefit this veteran so she asked if I would speak to him one to one with her there as well and explain the program to use it to try to buy his interest we did have a conversation he said well I'm too young for this kind of program and you and I'm you know I most likely will be one of the younger veterans in the program and I said you may be but I know you definitely are not the very youngest we have others that are younger and really this is a program to help our veterans stay in the community and you can even just observe the program and us your observations on how we can improve the quality of the program after observing you don't have to enroll in it indefinitely so he agreed this veteran also he does live at home alone he doesn't have any caregiver so recently he spent a day observing the program and after the observation I questioned him and asked him about his satisfaction of the program and his observations of how we can improve and he looked at me we just had the one-to-one conversation but he raised his voice so that everybody that was at the program participating could hear and he said Karen a few months ago I had plans my plans failed I'm very happy I failed in my plans because I now have a meaning for living yes i love the program i will return and I don't have any recommendations of changes so since his enrollment you know we've seen him evolves and we've seen him grow and and and sees his mood changing in a positive aspect and after some time participating in the program he came back to the program in he was we saw a whole change in his personality the staff asked him and said what happened what you know you really look like you something happened in your life and he expressed to the team and all the veterans there that his friend had committed suicide the night before and he only wished that he could have helped him and reached out to him and get him the help that he needed as in the help that he's receiving so the whole team we you know immediately called his provider his care manager we got everybody involved to help him through this difficult time and the amazing thing besides that the strong and supportive staff the veterans that were participating in the program helped to support him through this difficult time since then he continues to come back he participates really well in the program and he is he's resolved those issues of sadness and depression losing his friend and he has not had any thoughts or talks of suicide or any kind of you know ideation for suicide thoughts so that's our first veterans story of how he got involved into this program and how it has made an impact on his life next we're going to go to a second story about a 70 year old male United States of Vietnam veteran with the medical history of vascular dementia nicotine use alcohol abuse chronic obstructive pulmonary disease type 2 diabetes exposure to Agent Orange hyperlipidaemia and macular degeneration this veteran was not a participating a veteran in our mobile veterans program what had happened was at the post the office manager came running in to the VA staff and said I need a nurse out in the parking lot there's a veteran who is bleeding from his head he has a head wound and can somebody come out because he's refusing for us to call 911 call so we have a licensed practical nurse on the team she ran out to the vehicle with her supplies she gently provided first aid to this veteran she noticed when she was cleaning his face that he had a wound over the left side of his forehead down his eye down to his eye so she gently applied first day cleaning him and speaking softly and calmly and caringly in a relaxed manner she recommended to him the importance of seeking medical treatment now as in a hospital emergency room setting with her calming her relaxing her supporting and her caring attitude he finally agreed another staff member called 911 the third staff member was in the program maintaining the program with all of the situation occurring in the parking lot and also in keeping all the veterans inside calm and the medics arrived the licensed practical nurse she gave a handoff communication to the medics of what she found when she found this gentleman so as it turns out he did he went to the hospital he received treatments he received multiple sutures in the area to close the head wound and he was examining valuated the staff immediately contacted his VA primary care provider to explain the situation and the need of a follow-up appointment after his emergency room visit he did get an appointment we he saw his provider and his VA provider is the one who removed the sutures when it was time to have them removed so the veterans outcomes the veteran came back to the program thanked all the staff for helping him out and he opened up to the staff explained that he believes he had the head injury from falling out of his bed hitting a bedside bureau and causing a laceration on his head he thinks he was drinking too much and and he wanted to join the program his outcome is that not only did he join our program and is coming weekly he also joined other community programs as an AAA and he's receiving multiple supportive services he's mending his relationships with his broken relationships were with his family and his he's well kept he has a content mood and he seems so it seems like a different man from with the first time the staff had met him so that is his outcome and like I said he continues to join and he loves the program now with that being said we have our staffs outcome our staffs outcome where they were submitted for our hospital for a coin of Excellence Award and this is for staff at our hospital who take immediate action where by such action results in a favorable outcome for our facility and that such duties are above the normal requirements of the said job description and responsibility this gentleman really wasn't in our program they asked for help and the staff came out running to help this veteran in need so to the left of the photo is our LPN our licensed practical nurse that's Adrian Watkins next to her is Lisa Wilson next to her is amber howre and she's our recreation therapist and on the right is our hospital director mr. Gary divan ski so that is our second veteran story access to care our VA mobile veterans program is a hybrid of an adult day health care program it's and it's a collaborative partnership between VA medical centers and local veteran service organizations that increases access to care but by providing services in the community near the veterans home this is our secretaries number one priority secretary Bob McDonald this number one priority is getting access to care in the community for our veterans so the veterans are like I said are very satisfied with this program we are there facilitator it seems with their VA providers when they need something we communicate with them their providers immediately and we're able to get what they need when they need it while they're living at home okay here's our here's some of the things we offer in this program we offer an individual plan of care we offer as i said earlier coordination with our VA primary care teams or pack teams we offer casement care management we offer a therapeutic exercise including coping strategies accepting help taking care of yourself and reducing stress we offer many leisure activities we offer personal care including hand hygiene and today is as we all know it's May 5th and today is the World Health Organization World hand hygiene day so remember clean hands count for safe health care that's my nursing piece we're always trying to maintain our veterans health and well-being and preventing infections so one day a month what we do is we we give the veterans a wii mini manicure basically so they soak their hands in a warm soapy solution and we trim their nails and file their nails and they go home their families their their caregivers have told us that that day we do hand care they really sleep well that evening we also provide nutritious and regular snacks as well as sugar free snacks for the veterans we provide caregiver support for the veterans caregiver education we provide dementia care education and rest the time for the caregiver some special features that we've been able to offer in the last year are we had our hospitals respiratory therapists come in and she provided a lung health before the veterans that's including veterans who have CPAP machines and who have a diagnosis of sleep apnea and smoking sensation thoughts in trying to encourage them to stop smoking we also had a dietician who came in from the hospital and she provided diabetic education for veterans as well as she ended with nutritious smoothies for the veterans and they really enjoyed that another of whatever we were having this month which is going to be interesting and I some change for the veterans are we're having a pharmacy to pharmacy residents coming in and they're going to provide education to the veterans who are participating in the program regarding diabetic education with considerations to diet exercise medication administration checking blood sugars and medication adherence important drug to drug and drug to food interactions and how to properly dispose of medications so we're always looking for new ways these and new ways to educate our veterans and keep them home and healthy we have all of these we have to take into consideration safety and we have a safe supportive environment for our veterans all sites of care are veteran service organizations or VFW's or american legion's they're centralized sexualizing located in our catchment areas they have ample parking and our ad a compliant with easy accessibility to public transportation the sites of care are inspected yearly and based on the requirements of the chapter 17 in the most current edition of the National Fire Protection Association Life Safety Code which includes monthly safe environment inspections and we conduct also monthly fire drills with the veterans this is our team and this is why i said it's basically a hybrid of adult day care we have a recreation therapist it consists of you know basically four employees a recreation therapists and licensed practical nurse a certified nursing assistant and a nurse coordinator other resources supplied by the VA are advanced the staff to travel to the site of care activities supplies incontinence supplies and bagged lunches we also have only the team has received various staff competencies to take care of this patient population some of the competencies that they have received is knowledge of memory loss disorders understanding behaviors validation therapy to manage difficult behaviors strategies for daily care mealtime and eating dementia safety and that's including driving fire arms medications and falls meaningful activities caregiver self-care because we do communicate with the veterans primary caregiver all the time and at each site they have an annual verification competency about the facilities safety so they have to know where the important things are as in the telephone if they have a telephone the part of the fire extinguishers and and the exits and the exercise have to be lit so these are all the safety aspects that the team learns before they go out into the field one other portion that I would like to add to this team that it was unintentionally miss our volunteers we have and we have volunteers as some of the sites we don't have them at all but we're working on getting more volunteers we have at once I for volunteers to accommodate the needs of the veterans and most of the other sites have 11 site doesn't have any volunteers and like I said we're working on that because those people with dementia frequently have to have one to one type activities to keep them engaged in pro in programming so we really appreciate our volunteers and they really helped us out an awful lot during programming time here's our program history it was initiated by the Canandaigua New York the VA Medical Center in 2011 the initial funding was provided through a competitive peer review grant from the geriatrics and extended care non-institutional long-term care selve initiative of new models of care as part of the VA transformation to the 21st century that site received the 2011 New York organization of nurse executives best practice of wars it was later expanded to us here at the Coatesville VA Medical Center in 2014 at that time the veterans were enrolled in the program they did not care for this name so they selected three names and all the veterans voted on changing the name to VA MVP or Veterans Affairs mobile veterans program and that was effective in September 2015 the name change of our program here in coatesville our current program in canandaigua exists at canandaigua and the coatesville area the veterans have raided the program very highly in satisfaction our coatesville mobile veterans program achieved the following recognitions it's the Joint Commission identified it as a leading practice it was nominated for the rosalinda gilbert innovations and Alzheimer's disease caregiving legacy award it was nominated for the Hearst health prize for excellence and population health and it received honorable mention on the vh a pulse promising practice and it's includes it's included in the under secretaries book the best care everywhere if some preliminary demographics of our participants in their war here and does our highest population in the program are is our Korean veterans at thirty-three percent and then our next would be twenty-eight percent of our Vietnam era veterans and then it goes to World War two veterans at twenty percent and then post Korea at eleven percent and Persian Gulf and free Korea at three percent each additional graphics of their branch of service are we have number one the army at fifty-seven percent the Navy at twenty-four percent Marine Corps at eight percent Air Force oh I'm sorry Air Force at nine percent Marine Corps a percent and Coast Guard at one percent we have 145 men enrolled in the program and six women the age range is from 54 years old to 101 years old some additional demographics include the patient's diagnosis this has been really interesting for us at our facility and probably other VA facilities our veterans of problems list can span from eight problems up to 88 in this group that are attending the program so what we did we kind of brought them down and try to individualize them to the list that's on the screen right now as with stress disorder dementia diabetes depression lipid disorder hypertension and coronary artery disease as you can see the lipid disorder is the highest and then hypertension followed by dementia and the coronary artery disease the sea as you know the research shows that some of the risk factors for cognitive impairment includes hyperlipidemia and hypertension and cordon Airy artery disease so these many of those veterans have not yet been diagnosed with dementia but they may be in the future so we're going to be monitoring that to see if that does happen we have this program to be a win-win situation for our veterans our caregivers our veterans service organizations and the VA as well as the dedicated staff the v8 mobile veterans program has been successful in numerous areas that directly and indirectly benefit veterans and their caregivers through activities such as improving access to care to support services in the community for veterans and their caregivers increase veteran and caregivers scores for satisfaction rebuilding a public trust through partnerships with our veterans service organizations increasing the well-being and quality of life for veterans by empowering them to remain independent and home-based and also we receive unsolicited donations this includes hot lunches at some of the posts that have a open and functioning functioning kitchen the veterans really enjoy that hot lunch rather than our bag lunches and some of the posts who don't have a fully functional kitchen they'll donate takeout lunch once a month for the veterans as a treat other unsolicited donations of dumb at one of the posts the beautician down the street heard what we were doing she came in introduced herself and she asked if she can donate once a month hair trimming for the veterans so she comes in once a month at one site and trims the veterans hairs that usually we coincide it with the hand hygiene day so it's kind of like a mini spa day for the veterans and they just love it we also have received some cash donations to help support the program in buying supplies you know snacks or activities for the veterans and it's been the veterans have been like I said loving every portion of the program as well as the caregivers they really they can tell us enough how much they appreciate that respite time for them right here this is a photograph of our Veterans Day 2015 that took place our our parade here we had the veterans fully involved in it they created and cut out the stars for our van and they created the posters on the van and some of the veterans were at the parade and we celebrated them they since they change the name to mobile veterans program which is MVP and most valuable player they all dressed up in their favorite sports uniform and they either walked or rode in the parade with us so that's just a photograph of the front of the van and and then here is a picture of the site each one of them at each post they created their their themes their sports theme or their local theme for the parade and their posters are put on the van so many of them you can see their name there's Liberty Bell because we're in the suburbs of Philadelphia there are Eagles so they had they had a great time this is a great activity for them this are some of the things that they ask them what does this program do for them and they gave us one word answers like confidence pride and they like I said are just loving this program so some of our barriers and solutions really our biggest barrier was finding safe sites of care many of the buildings were very old and may not be handicapped accessible but all the ones that we do have sites of care they are handicapped accessible they're located within the community they have ample parking and they're easily accessible to public transportation some of our outcomes are that we have a 151 unique veterans participating in the program veterans satisfaction is rated at one hundred percent from very good to outstanding the veterans also share report that they would they would they would be just sitting at home doing nothing and that they were happy and look forward to programming caregivers have reported their perception is that they're seeing an increase in socialization in their loved one and cognition and functional status of their loved one of the cumulative total veterans enrolled in this program one veteran was institutionalized for long-term care antibiotics and and so we prevent an institutionalization by 98.9 percent at each time at this time each side is visited once once a week and veterans have requested two days of programming at each site we've also seen a decrease in the primary caregivers burden just going back to the top of that slide of the 151 unique veterans we currently have those were ones that have been enrolled in the program but we have a 88 of them who are totally involved and enrolled in acts actively participating in the program I'm going to give a little bit of information about caregiver support and I'll give you a caregiver support story as well our mobile veterans program systematically reviews through education with the veterans caregivers problems including dementia with psychiatric symptoms personality changes behavioral changes it assists the veterans caregiver and offering respite care while our veteran is receiving therapeutic socialization and recreation here's our veterans caregivers story we have a 77-year old host Korea Army veteran with the past medical history of multi fark dementia with depression and a very depressed mood he has a seizure disorder type 2 diabetes hyperlipidaemia hypertension osteoarthritis to reach to cerebral vascular accident accidents and colon cancer the subsidy the this veteran was referred to us from his VA primary care provider and they basically told us that he his his caregiver has called 911 for physical and verbal abuse that he was doing to her so we offered her all of our programs to help her in him and a one additional program is the caregiver our dementia caregivers support and education in the home so we offered that to her while her husband was attending our mobile program her his wife was 72 years old she has spinal stenosis type 2 diabetes and hypertension so along with the caregiver education in the home and the respite care coming to the mobile veterans program Sarah burden score decreased in six months from 11 out of a potential 16 to five out of six 16 and and this was this was a happy and significant drop of six points she in March he was seen and his geriatric depression scale we use the Jerry depression scale that's a high square with 15 points and if they will be severely depressed if it was 15 out of 15 he scored nine out of 15 and he it indicated that he wasn't satisfied with life he feels his life is empty he feels bored helpless worthless hopeless does not feel full of energy and feels that others are better off than he is recently he came back to the clinic had a repeat geriatric depression mind you he's been involved in the mobile program for six months his wife received home education and support and continued caregiver education and referred to caregiver support groups his geriatric depression screen dropped two points he ended up losing his feelings of being bored and hopeless after participating in the program and and it was really a great thing for both of them they are doing so much better now the potential you know the reasons for calling I'm one may have been related to a medical issue that was cropping up on him and he did have a hospitalization for a short time I would like to share two letters one that the wife sent us on her Sarah bird and interview that she wanted us to alert us about and the second is a letter that he wrote to the veterans participating in the mobile program so the first letter from his wife the veterans name is to is George so she writes its after she filled out her zeref burden survey she said it's a going to note that the Tuesday mobile veterans program has been wonderful my spouse has been ill and missed a few weeks due to an illness this definitely makes a difference in my week and allows me some free time also your program and the activities are very well-run and George likes to come and looks forward to the program thank you for everything all of you do for us keep up the good work the second letter what we did we ask we ask the consent of the veterans wife and the veteran if he would ever mind if we had to participating veterans who write him a get well card so all the veterans wrote a get well card and we VA staff put it in one envelope and mailed them all together to him and the veteran writes dear friends thank you one and all for your caring thoughts and your lovely notes said to me during my recent illness I miss my friends and the great times we have at our VA sessions I'm happy to be back today I wish each of you good health and lots of fun and I just thought that was beautiful thing that I just wanted to share with you here are our referral sources and and compost we receive we currently receive our consoles from the cultural VA medical center facilities patients align care teams or pack teams we also receive them from our VA mental health clinics from our geriatric and extended care services as in discharge for many community living center we also receive it from our home base primary care providers our VA Medical foster home program and one of our fast and growing referral sources our word of mouth for the participating veterans in the mobile veterans program to their comrades these are sub a list of some recent non-va presentations and really the reason why we have them up here are for two reasons one partnership we want to build partnerships and develop relationships so that we can share this program with everybody as it turns out last year was presented at the Pennsylvania State VFW annual convention and with that we were invited to the National Convention bfw convention this July in charlotte north carolina some of the other presentations we wanted to share it with the giant illogical society there's a lot of people there are a lot of providers to let them know that this is a program out there and available and as well as the American Nurses Association but primarily this slide is to help partner and developer relationships our future plans changes and improvements we are ongoing partnership with our VA path teams our home and community based programming and community resources ongoing assessment formal and informal of veterans needs to live safely in the home and delay or prevent institutionalization we're going to be starting up shortly video visits with veterans caregivers to to continue our dementia care education and support in the home and we would love to expand the program offering a mentoring partnership and potential for start of fundings within the VA so we also started this year of a research protocol and I you know just briefly so you know we look at cognition of veterans all the time in the memory clinic and I can give you an example of one veteran who participates was participating the program and this is from us he's been participating for six months he started coming to our VA in April of 2010 our tool for measuring cognition is the st. Louis University Mental Status exam and in April of 2010 his score was 21 out of a potential 3030 being he would have a perfect score and answered all of the questions correctly in March of 2014 he scored 15 out of 30 which is a six-point drop he started the program in June of 2015 and came back to the clinic in December of 2015 his score went up his his st. Louis University Mental Status exam went up two points to 17 out of 30 so we're always looking at ways to improve through research and we're just starting the reefs component of that now and I believe that we're going to be able to publish a lot of research shortly I want to thank you for listening and here's our contact information want to thank the RTI international for having us and what are your questions great thank you so much Karen for your presentation we will move to the questions now if you have come in while you were speaking and some you answered during your presentation some are new so just for the participants as a reminder you can enter your questions into the chat feature of the webinar and can you one of the questions that came in a few times is can you go over again the location all the locations where this MVP program is currently offered it's offered in Canandaigua New York and also here in coatesville at the code in our coatesville VA Medical Center we have five sites of care in our community here one is in delaware county in folsom pennsylvania we have another one in Downingtown Pennsylvania another one in parkesburg Pennsylvania another one in Spring City Pennsylvania and another one and let's see I think that if let me see I think there might be one more the one more site of ours is a Westchester West Chester Pennsylvania downingtown parkesburg Pennsylvania Spring City Pennsylvania in folsom Pennsylvania canandaigua offers the program up there they have it four days a week up in Canandaigua New York I'm not sure of their locations but if you were to call the candidate with VA they do have a person who is responsible in the director of the probe that can let you know the site's up in Canandaigua New York like I said earlier we see the wonderful outcomes and we are hoping that this program can be expanded to other VA locations across the country and a few questions came in asking about if there is an expansion plan in place currently to expand a few in particular someone asked about New York City another person asked about New Jersey I'm sure everyone's wondering if there's expansion plans in place or if this is something that folks out in the community or in the individual VA locations would maybe contact you about what kind of information can you give people of how to find out about expansion opportunities and well to start that answer sure hi this is Karen Massey and what we're trying to do is establish mentoring partnership so that the expertise from the sites that have already implemented these programs can be shared within a span shin site so indeed contacting Karen elico to see if she would be willing to mentor your program would certainly be possible i would suggest also copying me on it we have very limited startup funding available and we offer it to those who are interested in applying for a mentoring partnership it's it's not a long application process and it's usually based on the original proposal that the mentoring site submitted so the mentor kind of submits it for you and with a request for any kind of start-up funding that may be sought to begin the program so that's kind of the basis on it but sir to reach out to Karen and Karen Karen elico and Karen Massey are with our contact information on that slide if there is interest in expansion to other sites within bha I want to take a moment and also mention that I strongly feel that this is a program that could be done in local communities to and I've reached out to a couple of people and places in a couple of communities where I live to see if they would be interested in starting this kind of thing up with volunteers to provide caregiver support in a community near where people live I mean that's beyond VA but I think that it's something that we we could consider trying to promote thank you thanks so much so quite a few other questions are coming in someone was asking about if you've looked at any outcomes associated with decreased emergency department I use or unplanned hospitalizations what we do is we look at the we have urgent care visits here and I've been monitoring for our our own Hospital urgent care visits related to behavioral issues and we have had out of the hundred and fifty one and over a two-year span the we had two veterans who came to our urgent care and it was one was having a major medical issue going on the other what veteran was he reconnected with a son that he hadn't talked to for about 20 years and he asked him to bring him here see but but really they weren't behavioral issues related to dementia they were more related like I said the the first one to a medical issue in the second one to a psychosocial issue and but otherwise we aren't monitoring in the community you know a you know urgent care emergency room visits because a lot of times we aren't made aware of them and and if we can open up those communications that could be a great thing to monitor hi have we lost the connection or they're talking on mute maybe I think we might have lost Syria for a moment we can go ahead answer a few more questions while wait for her return there's quite a few questions about the expanding this program to other sites or states hopefully I kind of answered that and for people who would like more information there welcome to reach out email is best usually and can provide a little bit more detail or information is it's needed yes we have a full standard operating procedure for the program and we really have wonderful brain activities for the veterans or anybody it doesn't have to be just veterans that fully involve is involve everything with the veterans basically we have some veterans who are bilingual and they're teaching us you know easy languages and the veterans who are at the program love it the other activities we do a lot of different kind of board games as in scrabble and we read the newspaper current events we do a lot of creative arts type activities we some of the veterans of instruments and they do a presentation on their instrument for the group it's really a lovely thing one veteran his his his st. Louis you know a mental exam was probably a score of four out of 30 and but he can play a beautiful trombone and he brings that in and he entertains the group so we have we're starting with technology to with the veterans you know we talk about exercise within their limits nutritious foods that they should be eating and the importance of socialization we all of the activities we call them cranium crunches and all of the activities that we create for the cranium crunches in the program are basically using their five senses and we expand on that because as long as we use our scent our senses then we can help we can help maintain our brain and keep it functional as well and keep our our bodies functional we also do chair yoga and Tai Chi in the program and and they also have a group is called exercise sitter sighs the college as they do is chairs chair exercises and another exercise is dancing your worries away and the veterans veterans are doing dancing a lot of times their spouse or caregivers come in early and they participate in the program as well another way we're going to expand the program is have we're hoping to have a caregiver support group at the at the end of the program so then in a portion of the hall we can have a support group and the veterans will participate in the program in another area so these are all things that we're thinking about the future and triangle not sure if there's any more question I we have one we have questions on how your program is regulated and whether you have issues with states relative to service delivery and licensure we actually do not have a license I what we what we do the only license that we do have is a revocable license with the site so that we can use their site for those four hours so it's it's government employees coming in using their space for four hours but regarding licensures they're thinking since this is a hybrid new program that we may be surveyed by Joint Commission and possibly karf in the future but that's you know something that's going to be happening in the future it's not today but we probably will be surveyed shortly there's a question here about how you coexist with the other adult day programs in the areas that you're serving if you have had any experiences with the other day cares in the in the community how do you coexist we we do have a caregiver we do have other programs in the community a lot one of the sites in fact have a lot of caregiver support education conferences so the sum of our caregivers go to that during the time that the veterans are at our program we have a lot of veterans in our area and we have a lot of veterans who are attending the non VA programs so we do support them in the community and they have you know we haven't had any challenges or issues with any of the community programs because what we found to a lot of the community programs our veterans that are participating in this program may have been discharged due to behavioral issues but their work they are working in this program so we really don't have we coexist with them really well and we also use them you know it's just that sometimes sometimes they don't work out in a community program but they work out really well in our program it could be we're thinking that is that comradery for the veterans being together we're really not tutor but that's something we could research but we do pay for our veterans to attend the non VA programs in the community as well week like I said we have a lot of veterans in our program like I said there's 88 right now but I think in our community programs we have well over a hundred veterans that are attending community programs in our catchment area of our hospital except the VA is paying for great thank you for clarifying that so we this has been wonderful and and we have actually ended up with a lot of questions that haven't been answered and we'll do our best to get some answers to some folks thank you so much for all your time and work and I don't know about the other people but I got lots of goose bumps while I was listening to the stories they always help really give paint such an amazing picture so thank you for your time for putting putting the presentation together and sharing this we definitely based on the comments have a lot of people want to know more so that's we always find that exciting with our webinars so it's four o'clock we're going to close things up now if we have fairy Schumann and my my Erin Long's contact information in the discussion no box if you have anything any questions about the presentations or comments about the presentations please contact either Sarah or I and I think that the presentation that with everybody that was registered will be receiving a copy of the presentation so thanks again and I hope everyone has a nice afternoon thank you thanks for the participation yes yes thank you so much

Author Since: Mar 11, 2019

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