The voices of Urban Institute's researchers and staff
July 21, 2014

Quality care for veterans: Can the nonprofit sector save the day?

July 21, 2014

If you’ve been following the news, it’s no surprise that the Veterans Health Administration (VHA) is struggling to provide adequate services and care. Lawmakers are considering the creation of a commission to evaluate the VHA’s actions, but the Office of the Inspector General already serves that purpose. Instead of adding another layer of bureaucracy, lawmakers should consider expanding patient advocacy.

Currently, each Veterans Affairs (VA) hospital has at least one patient advocate (PA) on staff. PAs work with veterans and their families to assist them with navigating the VA healthcare system, from scheduling appointments to clarifying and resolving issues related to patient rights.

But the VA lacks the capacity to properly execute its current Patient Advocacy Program, and PAs are overworked, responsible for unmanageably large caseloads. These and other challenges have led to the inability of the current system to provide timely health care, which has consequences for veterans and the VHA.

Studies show that waiting for an initial health screening could further complicate existing health issues and increase the number of preventable hospitalizations, and missed opportunities for early detection and delayed treatment may accelerate the deterioration of a veteran’s health. And in the long run, improving access to health care could lead to a better quality of life for many veterans and ultimately reduce medical costs for the federal government.   

Outsourcing PA work: Potential benefits

  • The VA could strengthen its capacity to provide quality care to veterans and achieve its quality standards
  • The VA could identify and resolve problems before they escalate
  • Each veteran could receive the support they need to successfully maneuver the VHA system

So why NPOs? Here’s why I think they could get the job done:

  • They’re currently assisting military veterans.   According to Urban’s National Center for Charitable Statistics, there are over 40,000 NPOs throughout the United States dedicated to veteran affairs. The VA currently contracts with NPOs to provide hospice care, adult day care, case management, nursing home services, transitional housing services, homeless housing services, substance abuse treatment, injury rehabilitation, and counseling services.
  • They’re an untapped mine of transferrable skills. The aforementioned services are difficult to provide without rendering some form of advocacy for the client/patient, so more than likely, NPOs are already advocating on behalf of the veterans they serve. For example, it’s probably safe to assume that a program coordinator at a homeless shelter will know how to advocate for veteran services that are beyond the program scope of the shelter.
  • They’re an integral part of the communities where veterans live. The problems that lead to poor wait times occur at the VA hospital level. Since most NPOs are a part of the fabric of communities served by VA hospitals, NPOs are not only familiar with the population, but they are properly situated to provide support.

So how can we integrate NPO services into the VA system? I would suggest somewhat of a hybrid of the “one stop” model used by the Veterans One-Stop Center of Western New York, which provides streamlined social and health services for veterans, and the “one stop” model used by the Department of Labor to provide career services in various cities.

Increasing the VA’s capacity to provide each veteran with a single point of contact in a PA has the potential to improve the interaction between veterans and the VHA, and the potential to positively impact health outcomes.

Photo: Travis Fugate, a member of the Kentucky National Guard who was blinded by an IED attack in Iraq, wipes his eyes as he testifies on Capitol Hill in Washington, Thursday, May 29, 2014, before the House Veterans Affairs subcommittee on Oversight & Investigations. The panel is examining inadequacies in the Veterans Administration's treatment of visually-impaired veterans. (AP Photo/J. Scott Applewhite)

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