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BVA is becoming increasingly concerned about what appears
to be an alarming trend. It seems that some of the BRC managers,
in an effort to please facility and/or network managers, are beginning
to support shortcuts in the individual training programs to achieve
further reductions in length of stay. We will be closely monitoring
this issue in an effort to validate this practice.
The unconscionable backlogs we have complained
about in the past appeared to be becoming more manageable with
the exception of the Computer Access Training Section (CATS).
Much of this improvement can be attributed to changes in the blinded
veteran population being served in the BRCs. The effectiveness
of the professionals formulating individualized rehabilitation
plans responsive to changing needs is also a major factor. The
improvements reflect advancements made in technology available
and adapted for blind people to enhance independent living. The
residential blind rehabilitation program has evolved during the
past 52 years in response to changing needs. VA BRS retains the
same pioneering spirit that produced the premier service model
in the world. It is clear they must not rest on their laurels
as they are continually challenged to respond to changing needs
with innovative, high quality services. If this quality of service
is to continue, the subject matter experts must be the architects
of new delivery models, not managers concerned only with the bottom
line.
In an effort to reduce the length of wait
for admission to the CAT program, BRC Chiefs have historically
converted beds dedicated to the regular basic adjustment to blindness
program, to beds dedicated to CAT. As a result, the waiting time
for admission to CAT is declining as the waiting time for the
regular program is once again on the increase-- a trend we oppose,
as priority must be given to the regular program emphasizing overcoming
the handicap of blindness. Rather than reducing access to the
basic program, BVA feels that local contracts could be used to
provide the computer training. It would therefore reduce the workload
on the BRC CAT program, once again freeing beds for the basic
program.
It seems clear that when facility or network
fiscal managers are tasked with achieving cost saving, they only
look at the bottom-line figure in the aggregate and individual
programs. When any program stands out as being expensive, such
as blind rehab, it is targeted for cost savings. The only objective
is to reduce the cost of the particular program without any knowledge
or understanding of how the program operates, what its objectives
are, what outcomes are being or expected to be achieved, or what
professional resources are necessary to provide those services.
Two specific examples come to mind: First, I already mentioned
the demand that the number of discharges be increased over the
previous year. Second, another blind rehab center has been told
that it must reduce the average length of the program by eight
days. The justification for the requirement is to reduce cost
regardless of whether the rehabilitative needs of the veterans
are being met. How long a blinded veteran needs to be in a blind
center is a clinical decision that must be made by competent blind
rehabilitation professionals, not budgeters or unqualified administrative
officials. The length of stay is also directly determined by the
individual veteran's capacity to learn new skills and gain confidence
in his or her ability to integrate these skills into his or her
daily activities. As we all know, everyone does not learn at the
same rate. Historically, the VA Blind Rehabilitation Program has
provided blinded veterans with sufficient time and repetition
during training to allow the veteran not only to acquire but also
master a given skill. As I am sure you can imagine, being introduced
to an adaptive technique or skill is not the same as mastering
its application sufficiently to gain a reasonable level of confidence
in one's ability to utilize that skill on a daily basis.
The other major contributing factor to length
of stay is how quickly a veteran is able to make the emotional
or psychological adjustment to sight loss. Acquisition of skills
is of no value if the veteran has not achieved a healthy level
of adjustment. A blinded veteran who remains chronically depressed
about his or her blindness or cannot accept himself/herself as
a blind person will certainly not utilize learned skills. These
individuals tend to return home and resume a very withdrawn and
dependent lifestyle. The adjustment aspect of the residential
Blind Rehabilitation Program in many ways is the most critical
factor. Unfortunately, it is also the most intangible in terms
of measurement. The first chief of the Hines BRC in Illinois has
frequently noted that before blinded veterans can successfully
acquire the necessary adaptive skills to overcome the handicap
of blindness, they must first get their head screwed on straight.
In other words, they must develop healthy and wholesome attitudes
about blindness. From a cost-benefit standpoint, arbitrarily reducing
the length of stay in the program will only result in veterans’
failure to make the necessary adjustment to sight loss. They are
then incapable of acquiring the essential adaptive skills to assist
in overcoming the handicap of blindness.
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