Images of wounded warriors returning home from Iraq and Afghanistan strike a deep chord with the American public. The healing of these young veterans requires the very best care anywhere; there is no argument on that score. However, in addition to repairing the ravages of the current conflicts, the Veterans Health Administration (VHA) is also charged with caring for warriors of past conflicts, a challenge it anticipated in the years following World War II. Today, this mission is carried out by Geriatric Research Education and Clinical Centers (GRECCs) located across the country.
Those with an eye to the future realized that within 35 years, these service personnel would begin reaching the age of 65, all at roughly the same time.
Beginning in the 1950s, the VHA recognized that it would be dealing with issues of aging among the 16 million men and women who served in the U.S. military from 1941 to 1945. Those with an eye to the future realized that within 35 years, these service personnel would begin reaching the age of 65, all at roughly the same time.
“Initially, the VA was not prepared for that any more than the general population and the general health care system was,” Kenneth Shay, DDS, MS, director of Veterans Affairs Geriatrics Programs, recently said. “So the VHA considered how to prepare for that, which finally culminated in the 1970s with the funding of six Centers of Excellence in Geriatric Research, Education, and Clinical. The idea was that it would be a partnership between the VA and their affiliated schools of medicine, where research would be conducted into the aging process, the diseases that accompany the aging process; that the lessons learned from that research would then be shared with the existing workforce and would also be shared with health-professional schools.”
Shay described the vision for the centers as not only being research-oriented but also investigative. Institutional and nursing home care, geriatric care in other environments, different treatment modalities, care targeted specifically at the diseases of aging, and perhaps even treatment options for retarding or reversing the ravages of aging were envisioned.
The initial six GRECCs grew to 15 in 1980. Within another five years, 25 of the centers were on the drawing board. Through consolidations to take advantage of regional synergies, the number of centers now stands at 20.
“The VA faced these issues in numbers far before they became a big issue in the private sector and we’re very proud of that. And we played a big role in that, not in all the big new approaches to care but in a good many of them,” said Shay.
The successes of the GRECCs were not lost on private-sector health care systems. “The VA faced these issues in numbers far before they became a big issue in the private sector and we’re very proud of that. And we played a big role in that, not in all the big new approaches to care but in a good many of them,” said Shay. Many of the current approaches to treating and ameliorating the issues of aging began at the VHA’s centers.
Institutional-based care is expensive, not only in the private sector but also within the VHA system. A month’s stay in a nursing home averages about $6,000 per month at present, according to Shay. At a VHA institution, the costs tend to run somewhat higher and vary, depending on the center. The higher expenses derive from the cost of supporting attendant medical infrastructure; the centers are located within VA hospitals and the costs reflect the care and feeding of operating rooms, life-support and monitoring equipment in each patient room, and staff salaries.
Conversely, VHA home-based care programs carry a relatively modest cost of perhaps $720 per month per patient on average. Actual costs vary widely because each aging veteran may not need or qualify for all available services. The cost saving is attractive, but a bigger benefit lies beyond the balance sheet.