Shay credits the GRECCs’ special circumstances with the good retention rate that derives from providing excellent care, saying, “We have a capitated system, so it’s not fee-for-service, and we’re in a very privileged position to be able to do what’s right for the patient without needing to be as concerned about the bottom line. Of course, the bottom line is the bottom line at the end of the day, but it’s not so granular that we can’t make sure that we provide for the needs of the veteran. … ”

“Of course, the bottom line is the bottom line at the end of the day, but it’s not so granular that we can’t make sure that we provide for the needs of the veteran. … ”

Even with the blessings of capitation, however, the GRECCs across the country still must operate efficiently and effectively. Shay sees cooperation and collaboration among the individual centers and with private-sector geriatric centers of excellence as being a major focus over the next decade or two. “The GRECCs saw a need to redirect some of their resources over the past few years to ensure that they are really meeting the clinical needs of their parent health care systems and came up with these new and innovative approaches to care,” he said. “The big challenge is maintaining the balance between helping to contribute to the clinical mission of the health care system even after they continue to promote their very high quality scientific enterprise and the way in which they, I think, are accomplishing this is through those synergies and through those collaborations.”

Shay has taken a unique path to his post as director of the GRECCs. He received training as a VA geriatric dentist in the early 1980s, a course of study akin to that received by VA physicians. His skills as an administrator and as a clinician led to his becoming the director of a clinic and promotion to the head of geriatrics in a four-state VA region, ultimately leading to his present post.

“My particular responsibility within VA is to oversee the GRECCs, and I think that probably I’ve always had very strong ties with education and training. I did train other dentists in geriatrics and part of that training and preparing people for careers in academia always involves research and research communication. I think it was a fairly good match between my interests and GRECCs and geriatrics,” he said.

“Because of generational differences, they are far less likely to be vocally demanding of resources than the younger generation, which is much more accustomed to getting what they want.”

Shay regards competition for somewhat scarce resources to be another challenge for the GRECCs to meet; perhaps the biggest one. He applauds the level of care available for our wounded warriors coming back from Iraq and Afghanistan and is more than pleased by the way in which the country has embraced them. However, he is an advocate for the most frail and vulnerable of the U.S. veteran population. “The group I’m most concerned with is very old veterans who in many cases are very needy as well and are numerically vast in number compared to this much more visible segment currently,” he said. “Because of generational differences, they are far less likely to be vocally demanding of resources than the younger generation, which is much more accustomed to getting what they want.”

Ultimately, Shay’s take home message is that U.S. veterans range in age from perhaps as young as 17 to nearly 100. While elderly veterans may not be as visible in the media and in their communities, they too served their country selflessly and are deserving of the best possible care.

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Geriatric Research Education and Clinical Centers are found across the nation in the following locations: Ann Arbor, Baltimore, Birmingham/Atlanta, Bronx/New York Harbor, Cleveland, Durham, Gainesville, Greater Los Angeles (Sepulveda and West LA Division), Little Rock, Madison, Miami, Minneapolis, New England (Bedford and Boston Divisions), Palo Alto, Pittsburgh, Puget Sound (Seattle and American Lake Division), Salt Lake City, San Antonio, St. Louis, and Tennessee Valley.