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It has been proven through the years that blinded veterans that
have the opportunity to live with other blinded veterans on a
daily basis while undergoing intensive rehabilitation can optimize
their adjustment to vision loss. The opportunity for one blinded
veteran to share the problems associated with adjusting to sight
loss with other blind veterans has proven most therapeutic in
terms of instilling healthy and wholesome attitudes about blindness.
The intensity of the residential program clearly facilitates adjustment
along with skill acquisition. It is important to note here that
two of the BRCs are testing veterans in the program on degrees
of depression present upon admission and again upon discharge.
Preliminary data suggest remarkable improvements as a direct result
of the BRC program. I emphasize that although this data is only
preliminary, we expect that further data collection will validate
these early findings.
I would like to now share the thoughts of a recognized
expert in the field of blind rehabilitation. Father Thomas Carroll,
formerly the Director of the Catholic Guild for All the Blind
in Boston and consultant to VA during its early years of blind
rehabilitation wrote a landmark book about blindness. The book,
entitled "Blindness: What It Is, What It Does, and How To Live
With It," continues today as a "bible" for professionals in the
field. In his book, Father Carroll states that the person who
loses their vision must first grieve for the loss of the sighted
self. The grieving process varies greatly from person to person,
and the residential BRC facilitates this process.
Setting is the other ingredient that is so crucial.
In a therapeutic environment, such as a BRC, there is a certain
level of expectation. Many well-intentioned loved ones in a home
setting will be overly protective of the veteran. Family and friends
expect little or nothing from their blinded veteran and in fact
believe that people who are blind are unable to function independently.
The attitude in a BRC is just the opposite. The professional staff
expects blinded veterans to learn to be independent and to care
for themselves. They believe strongly in the process and the potential
of each person who is blind. Veterans in the BRC program are expected,
among other things, to take care of their own laundry, keep their
rooms clean, change their linens, and take care of their clothing,
including color identification. This atmosphere does not exist
at home but is essential if adaptive skills are to be learned
and integrated into activities of daily living. Successful completion
of a comprehensive residential program enables a blinded veteran
to regain control of his or her life and environment. One network
director has been quoted as saying that VA blind rehab is antiquated.
We believe he is referring to the residential or inpatient model.
He seems to be insisting that blind rehabilitation services should
be provided on an outpatient basis consistent with the transition
to outpatient-based managed primary care. This attitude does not
adequately consider and appreciate the importance of healthy adjustment
issues involved in the rehabilitation process. It only assumes
that all the same outcomes can be achieved more cheaply on an
outpatient basis. Again, we have no data to support this attitude
or opinion.
BVA argues that a concerted team effort must
be undertaken to achieve desired VHA goals and objectives, ensuring
all team members have equal opportunity to share input in the
decision-making processes affecting any VA service. Management
cannot ignore or exclude program officials or subject matter experts
when programs are subject to review cost savings. Program managers,
including blind rehabilitation officials, must be challenged to
engage in an honest, concerted effort to identify cost savings
without compromising quality care. We cannot emphasize this
enough. The quality of the blind rehab should never be sacrificed
in the name of cost savings. The blinded veterans rehabilitation
training program should be driven by the veteran’s particular
needs and ability to participate in the program.
Dr. Kizer had repeatedly stressed that his vision
of the VA health care system is one that is driven by outcome
measures. Decisions on clinical programs should be based on outcome
measures that validate the effectiveness and quality of that program.
BVA subscribes to this approach for validating program effectiveness.
VA BRS has completed the testing, refinement, and validation of
functional outcome measurement instruments for the residential
Blind Rehabilitation Program and has begun data collection. Unfortunately,
sufficient data has not yet been collected, prohibiting management
officials from determining the effectiveness of programs and from
driving any decisions regarding reductions of resources when appropriate.
It is anticipated that the outcome data will be available in sufficient
quantity this coming fall. The VA Rehabilitation Research and
Development Center at VAMC Decatur, Georgia is coordinating the
collection of this data and has worked in collaboration with the
private sector in the development and refinement of appropriate
instruments for data collection.
We are confident that when sufficient data is
available, it will validate the value of the residential blind
rehab program in terms of desired outcomes and cost effectiveness.
Preliminary data suggests that veterans with multiple medical
problems are more capable of independently managing those problems
following Blind Rehabilitation Training. This reduces their dependency
on VA for acute medical care. BVA has argued for years that blinded
veterans who had access to blind rehab would be less likely to
require hospitalization or nursing home care solely because of
their blindness. As older veterans particularly are more susceptible
to falling and incurring serious injuries that are expensive to
treat, providing proper rehabilitation training would significantly
diminish that likelihood.
BRS managers should be challenged to identify
or develop programmatic changes that might result in cost savings
without compromising quality. I submit, Mr. Chairman, that BRC
managers have undertaken this challenge. The statistics verify
that they have achieved significant changes resulting in substantial
cost savings without compromising rehabilitation. We are fearful,
however, that increasing pressures from upper management to reduce
cost will ultimately lead to BRS program officials compromising
the tradition of excellence achieved over the past 52 years. Blinded
veterans attending the residential BRC programs are evaluated
and an individualized rehabilitation treatment plan is specially
designed to address their needs. In our view this approach, patient
focused and needs driven, hits exactly to the core values
espoused by VHA. We submit that for many blinded veterans the
residential BRC is the right place to deliver these comprehensive
services. There is no mandated length of stay applicable to all
blinded veterans. The length of stay is determined solely by need
and the rate of progress necessary for the individual to develop
healthy attitudes about him or herself and blindness as well as
to acquire essential adaptive skills.
For each skill area within the comprehensive
program, lesson plans are designed to build upon success. The
veteran progresses to more complicated or advanced skill acquisition
only when he or she has demonstrated command of the skill being
taught. Systematically building upon individual success accounts
in great part for the overall success of the BRC program. The
pace at which a veteran moves from the basic to more complex varies.
Some may require more repetition than others-- an issue also driven
by the individual needs of each veteran. Some may require a greater
degree of complexity because of the potential lifestyle the veteran
hopes to resume when reintegrated into his family and community.
As the blinded veteran progresses in the program and gains proficiency
with new adaptive skills, one can observe a corresponding marked
increase in self-confidence and esteem. Contrary to what some
VHA officials would have you believe, the BRC program is not a
cookie cutter approach to service delivery. It is not "one
size fits all."
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