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Residential Blind Rehabilitation Centers are a most valuable component
of VA BRS. Clearly, there are those within VHA that seek to discount
the value of residential Blind Rehabilitation Centers. They desire
to systematically dismantle this service delivery model in favor
of a more cost-effective model. These individuals will argue the
same goals and functional outcomes achieved in the residential
program can be duplicated in an outpatient environment. We insist
there is absolutely no valid data to support this argument. In
fact, Mr. Chairman, preliminary data obtained from the BRS Outcomes
Project clearly contradicts this notion. It is absurd to suggest
that comprehensive rehabilitative needs are the same for all veterans
who meet the legal definition of blindness. Even more ridiculous
is the assumption that all blinded veterans can be served on an
outpatient basis. Without a doubt, there may indeed be a segment
of the blinded veteran population that can receive optimal benefit
from outpatient services. A clear profile of these veterans is
currently not available to VA BRS. Through valid scientific research,
the blinded veteran population can be segmented and profiled with
respect to which treatment modality is the most appropriate to
maximize rehabilitation. Until this outcomes data is available,
the residential program must be protected. We believe this
was the intention of Congress as outlined in the provision of
the Eligibility Reform Act requiring VA to maintain its capacity
to provide specialized service to disabled veterans.
It is important to note that not all VA BRCs
are currently operating all their authorized beds. For the most
part, this is the result of reductions in FTEE blind rehabilitation
specialist positions. These are the professionals directly involved
in the rehab training and five of the nine existing BRCs are in
this position. Mr. Chairman, here are four examples of today's
field mentality concerning the residential BRCs. First, one facility
arbitrarily closed fifteen BRC beds without any approval from
higher VHA management. The FTEE to support those beds has also
been eliminated. We fail to understand how this meets the statutory
mandate to maintain capacity.
The four other BRCs referred to have also experienced
reductions in FTEE. When vacancies develop in blind rehab specialist
positions, the BRC is not given authorization to recruit and fill
these vacancies. Consequently, the BRC is not able to operate
all authorized beds because of the lack of qualified instructors.
The BRCs are being told they must share equally with all other
services as the result of inadequate resources-- this despite
the fact the resource allocation model provides a much more generous
reimbursement rate than for basic service.
The reduction of operating beds is the direct result
of the loss of more than 50 FTEE blind rehabilitation specialist
positions. If additional reductions or freezes are imposed, it
is very likely that capacity will be further diminished. The high
quality professional blind rehabilitation staff distinguishes
VA as the world's premier provider of comprehensive blind rehabilitation
services. Unfortunately, these are the positions management officials
are targeting for reduction in order to achieve cost savings.
Maintaining a high quality program resulting in favorable outcomes
is directly related to the quality of the professionals providing
care.
On a more positive note, during the past year
several of the BRCs that have experienced the greatest loss of
crucial FTEE have been given authority to recruit to fill vacancies.
Unfortunately, the Western BRC located at VAMC Palo Alto, California
is experiencing severe problems in recruiting and filling seven
existing vacancies due to the incredibility high cost of living
in the Bay Area. Even with special rates designed to assist in
overcoming the high cost of living, potential employees cannot
afford to relocate to that area of the country. Unless something
can be done to mitigate this problem, all VA health care in that
region will be negatively impacted.
Despite the reduction of operating capacity
and essential professionals, more blinded veterans received comprehensive
blind rehabilitation last year than ever before. Moreover, the
length of stay has been significantly reduced. As a result, length
of wait is not as serious a concern as it has been in the past.
These are truly remarkable achievements and have resulted in cost
savings. At the same time, services have become more accessible
to blinded veterans. For the most part, this has been achieved
largely through the initiative of the BRS staff and the changing
needs of the blinded veteran population being served and not from
artificially imposed limits. Unfortunately, this does not appear
to be enough. Pressure is increasing to reduce these lengths of
stay. As an example, one BRC Chief recently reported he was instructed
to increase the number of discharges this year by 10 percent.
The only way to achieve this performance goal, however, is to
cut corners in the program or establish artificial limits on the
length of stay, regardless of the veterans’ needs. We believe
this is for the intended objective of increasing a perceived profit
margin. It appears that the challenge for these facility and network
managers is to maintain just enough of the residential bed capacity
to insure the attainment of the high reimbursement rate as provided
under VERA.
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