TESTIMONY BY
BOBBY L. HARNAGE, SR.
NATIONAL PRESIDENT
AMERICAN FEDERATION OF GOVERNMENT
EMPLOYEES, AFL-CIO
SUBMITTED BEFORE
THE SUBCOMMITTEE ON BENEFITS AND THE
SUBCOMMITTEE ON HEALTH HOUSE
COMMITTEE ON
VETERANS AFFAIRS
REGARDING
HOMELESS VETERANS ISSUES
MARCH 9, 2000
Chairman Quinn, Chairman Stearns and Members
of the Subcommittees:
My name is Bobby L. Harnage. I am President of
the American Federation of
Government Employees, AFL-CIO (AFGE). I appreciate the opportunity to offer our
concerns regarding the issues facing homeless veterans. AFGE is the nation’s
largest federal employee union, representing some 600,000 employees, including
some 125,000 employees in the Department of Veterans Affairs (DVA).
AFGE’s testimony focuses on the care of
homeless veterans in the Veterans
Health Administration’s (VHA’s) general inpatient and outpatient programs. AFGE
is
concerned that the budget proposal for FY2001 may undermine treatment of
homeless veterans in these programs. AFGE is concerned that VHA’s increasing
reliance upon contractors to deliver veterans with health care coupled with the
dramatic decrease in VHA’s in-house capacity for inpatient services and transition to
community based outpatient clinics may inadvertently lessen the access of care
homeless veterans receive.
About 45 percent of homeless veterans suffer
from mental illness and, with
considerable overlap, slightly more than 70 percent suffer from alcohol or other drug
abuse problems. Nearly forty percent of the veterans being treated in VHA mental
health beds were homeless or at high risk of homelessness.
VHA’s proposes for FY 2001 to reduce the
number of psychiatric care
patients it treats by 13,800. (See Volume 2, page 2-42 of the Department of
Veterans Affairs FY 2001 Budget Submission.) VHA also proposes to cut 1,200
full-time employees who work in psychiatric care in FY 2001. (See Volume 2, page
2-47 of the Department of Veterans Affairs FY 2001 Budget Submission.)
Adequate numbers of well-trained staff are essential to manage workloads, prevent
potentially harmful delays in care, avert medical errors, and improve services.
VHA also proposes to reduce its domiciliary
care beds by 759 from FY 1999
levels. (See Volume 2, page 2-102 of the Department of Veterans Affairs FY 2001
Budget Submission.) That is a 15 percent cut in a program designed to provide
medical care and rehabilitation in a residential setting to eligible ambulatory veterans
who do not need hospitalization or nursing home care. These beds are critical to
homeless veterans suffering from substance abuse and/or mental illness and
essential to the Domiciliary Care for Homeless Veterans program.
AFGE strongly believes these reductions in
in-patient care staff and VHA
domiciliary beds will seriously worsen homeless veterans’ access to needed
psychiatric care.
Chairman Stearns, we urge you to continue to
press the VHA for answers on
how these cuts in staff and patients treated will help homeless veterans who suffer
from severe mental illness. It is our understanding that most of the psychiatric
staffing cuts will come from support staff – the Nurses Assistants, Licensed
Practical Nurses and other lower graded health care staff. Without adequate
support and administrative staff, Registered Nurses would have to devote more of
their time to paperwork, maintaining hospital cleanliness, feeding, bathing and
transporting patients.
VHA proposes to increase its use of community
based outpatient clinics
(CBOCs) and contracted psychiatric care. Are mentally ill homeless veterans
served well by these initiatives?
A study by Dr. Robert Rosenheck, of VHA’s
Northwest Program Evaluation
Center (NPEC), examining veterans access to medical care from FY 1995-1997
concluded that CBOCs do not improve access to specialty mental health care for
either the general population of veterans or among veterans who received
compensation for psychiatric disorders. (See, Impact of Primary Care Satellite
Clinics on Access to General Health Care Services and Mental Health Services.)
The February 1999 CBOC Performance Evaluation
Project report suggests
that contractor operated CBOCs are less equipped to care for homeless veterans.
For example, only 63 percent of contractor CBOCs versus nearly 90 percent of
DVA-staffed CBOCs have available public transportation access (bus, subway or
Disabled American Veterans voluntary transportation). Mental health services were
provided at a higher percentage of DVA-staffed CBOCs (roughly 54 percent) than
contractor CBOCs (18 percent). DVA-staffed CBOCs serve veterans almost
exclusively while veterans were only a small part of the workload in contractor
CBOCs. Will contractors whose profits are based largely on serving non-veterans
encourage and welcome homeless veterans into their waiting rooms?
AFGE urges you to press VHA to demonstrate
that contractor CBOCs will
serve homeless veterans as well as DVA-staffed CBOCs. AFGE asks that you
direct VHA to study whether and how contractor-operated CBOCs increase or
decrease homeless veterans’ access to needed health care.
With regard to contracted psychiatric
inpatient and community based care,
AFGE is concerned that VHA does not have adequate staff or resources to assure
that veterans are provided with quality care and that these service are not subject to
waste, fraud and abuse by contractors. VHA is proposing to use roughly 200
contract community-based facilities to provide an additional 4,000 homeless
veterans longer-term medical treatment. The success of these contracts hinges
upon active VHA staff involvement and monitoring of the quality of care and
treatment in provided by contractors.
Of the veterans in the Little Rock residential
treatment program, 57.52 %
were discharged to their own apartments, compared to 32% nationwide in the VHA
homeless programs. Homeless veterans in the Little Rock program showed higher
improvement regarding alcohol abuse (75.6 % compared to 67.9% nationally), drug
abuse (82.6% showed improvements compared to a national average of 66.7%), and
in mental health status (85.7% compared to 62.9% nationally.) AFGE believes the
difference between Little Rock and other VHA programs nationwide is attributable to
the active oversight and monitoring of the contractor performance by Little Rock’s
clinical care staff.
VHA employees at Little Rock vigorously
monitor the clinical capability of staff
employed by the treatment facilities as a means of insuring that veterans are
receiving the services that we are contracting for, rather than just maintenance
services. VHA staff visit contractor sites 3-4 times a week and have weekly clinical
case management conferences. VHA staff use these sessions to monitor the
progress of veterans in following their treatment plans.
Such contractor oversight and active
involvement of VHA staff is critical
nationwide to ensure that the additional millions of dollars spent on contract
residential care for homeless veterans will truly help these veterans make the
transition into permanent living arrangements.
AFGE asks that you direct VHA to study how
oversight by VHA clinical staff
of contractor performance affects the treatment outcomes for homeless veterans.
This concludes my statement. Thank you for the
opportunity to offer AFGE’s
views on the treatment of care of homeless veterans.
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