VA providers are working together to provide culturally sensitive care to veterans of all backgrounds. Recently, two VA neuropsychologists teamed up to conduct a neuropsychological evaluation of a bilingual veteran through telemedicine. This successful meeting reflects VA’s national goals to improve VA health care services with telehealth.

It seemed like the veteran was really happy to talk to someone who could understand him, Dr. Ana Messler said. And there didn’t have to be that third party, an interpreter, stepping in in case things got lost in translation. It was really cool to see that happen.

A successful bilingual assessment using VA telehealth

Messler, a neuropsychologist at the VISN 20 Clinical Resource Hub, received a request for services for a veteran in a rural area. The referral provider was concerned about the safety of the veterans and whether they were developing dementia. The veteran required a neuropsychological evaluation.

Neuropsychological evaluations include a diagnostic interview and observations, as well as standardized cognitive tests to identify the cause of any cognitive, emotional, and behavioral changes. The neuropsychologist then recommends treatments. Tests vary based on the symptoms experienced by each veteran. They measure skills such as memory, attention, thinking speed, and problem solving. They can also predict veterans’ ability to manage independent living. Test performance can be easily influenced by language and culture.

The evaluation takes several hours. And it can be conducted in-person or via telehealth when the veteran can’t enter a facility. The assessment begins with a diagnostic interview followed by cognitive tests and discussion of the results with the Veteran.

During their first meeting, Messler discovered that the veteran spoke Spanish very well. He therefore decided that a culturally responsive assessment should be conducted in his preferred language. The veteran and his family welcomed him. Messler then contacted Dr. Yesenia Serrano to consult on the case. Serrano is a bilingual neuropsychologist at VISN 4’s Clinical Resource Hub and frequently works with Spanish-speaking veterans.

Traveling to a Spanish-speaking provider in another state was not an option for the veteran. Messler and Serrano then agreed to work together on telehealth assessment, collaborating on case planning. During the assessment, Serrano acted as an interpreter and administered tests involving language. Messler conducted the nonverbal portions of the tests.

Working with a Spanish-speaking provider made the assessment culturally relevant. It was more comfortable for the veteran. It allowed him to be more open with his responses everywhere. This has resulted in greater diagnostic clarity and more appropriate recommendations for treatment. Her caregiver also appreciated the culturally relevant recommendations provided by a provider with a similar cultural background. The veteran and his family were so grateful for the attention given during the evaluation process that, during the feedback session, the veteran exclaimed: Te amo !, in Spanish I love you!

The Power of Telemedicine VA

I think that’s just the power of being able to provide culturally appropriate assessments and having VA providers who have a variety of cultural backgrounds to help our veterans feel comfortable, Messler said. Because he was able to disclose this way, we were able to get the information we needed to help him.

The COVID-19 pandemic has provided opportunities to increase the availability and access of TeleNeuropsychology. VA neuropsychologists are empowered to better serve veterans across the country, regardless of distance from a VA facility. These adaptations allowed Messler and Serrano to help the veteran quickly and without traveling to a VA facility with a Spanish-speaking provider.

Telehealth removes the barriers we once had to reaching all veterans and especially veterans in rural areas, Messler said. And we can often connect with family members back home who may simply accompany them to visit or not attend. Thanks to this collaboration, the veteran was not only able to obtain language-compatible services, but also to be rapidly evaluated by qualified operators and provided with very important therapeutic options that truly represented a turning point in his care. We were able to offer the family ways they could support him.

I think telehealth has helped ensure equity and inclusion in terms of service quality and access to services, Serrano said. And it provides opportunities for VA facilities to work together.

Resources for VA neuropsychologists

Because of cases like this, Serrano and Dr. Julija Stelmokas, a neuropsychologist at the New York Harbor VA, Brooklyn Campus, have been working with other neuropsychologists to facilitate education and improve culturally sensitive neuropsychological care for veterans of all backgrounds.

Veterans should receive assistance in their preferred language, especially when it comes to mental health and neuropsychology, Serrano said.

Messler’s experience with the case sparked his interest in ensuring that veterans of all backgrounds can receive the care that is best suited to their needs. She recently published a literature review, co-authored by two other neuropsychologists, including Serrano, to show the benefits of using TeleNeuropsychology services for culturally and linguistically diverse populations in the United States and its territories.

I got really interested in learning more about TeleNeuropsychology with racially and ethnically diverse veterans groups. Messler said. I think a lot of times people have these questions, they have these cases and they don’t know where to go. We’re trying to encourage people to really want to know more, to develop this area of ​​expertise and to address it.

Serrano said he wants to motivate other VA providers to be culturally curious and to think outside the box to help veterans of all backgrounds.

I want suppliers from all over the world to not walk away from these kinds of cases, to approach and ask others to help and to keep in mind how much impact a little effort can have. It was a great effort on our part. But the result was a positive outcome for the Veteran and the creation of something greater.

According to AARP, which cites data from the US Department of Health and Human Services, about 70 percent of Americans over the age of 65 will need long-term care in their remaining years. AARP notes that along with aging, the possibility of physical or cognitive deterioration increases. Family and friends may not be able to provide adequate care, and it is estimated that more than a third of the aging population will need to pay for the care of trained health care professionals.

Long-term care insurance (LTCI) is one way to deal with this costly possibility.

Consumer advocate Clark Howard notes on his website that long-term care for women averages 3.7 years and 2.2 years for men. Without long-term care insurance, a family can deplete all of its financial resources to provide for themselves or elderly relatives.

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Gail Raab, owner and broker of Insurance Depot, has been advising families on LTCI options for decades. She tells the following story:

I sold a shared long-term care policy to a couple in their 50s. The wife was athletic, in good health, and she did not feel she needed long-term health care coverage. She wanted it for her husband who was seven years her senior, but I explained that she could buy a policy where she and her husband could share the total benefits. If one spouse needs more than 50% of the policy, the other spouses’ share of the policy may be used. Eventually she accepted and purchased the shared LTCI policy. In the first year, her wife had a serious illness that put her in intensive care for a month, in the hospital for another few weeks, and she needed a year of physical therapy and rehabilitation. During this time, she was unable to take care of herself and needed long-term care. She thanked me over and over again for getting her to buy the shared policy, thus saving their retirement funds.

While regular life insurance will pay out the nominal amount of a policy to beneficiaries after one’s death, it does not alleviate the financial burden of a physical or mental illness while the policyholder is still alive. LTCI, while expensive, fills that need and can be applied at home or in an assisted living facility or nursing home where the caregiver works in addition to the facility’s regular staff.

LTCI is customized to an individual’s desires and wealth. Options can include any daily allowance the buyer selects, starting at $100 per day or $3,000 per month. Other options include the waiting period or number of days before benefits start, including 30, 60, 90, or 180 days; the zero wait period for home health care that begins on the first day long-term care is needed, after which the days used for home care can be used to meet the waiting period in a facility; the number of years the policy will continue to provide benefits, including two to ten years or lifetime; and the inflationary factor of compound interest rates of 3% or 5% simple interest; or no inflation pilot. In addition, couples have the option of receiving separate benefits or shared benefits, so they can take money from each other if needed for long-term care. In general, premiums are not guaranteed and can increase, and the many options affect the cost of the policy.

Medical care for an illness or injury is covered by health insurance policies, Medicare, or Medicare supplements. LTCI, however, only pays healthcare professionals and does not provide any treatment. A long-term care policyholder becomes eligible for benefits when they are unable to perform at least two forms of self-care, such as dressing, eating, bathing, moving in and out of bed, and moving independently. Cognitive impairment automatically qualifies a policyholder for long-term care benefits.

Is long-term care advisable for everyone? Sheldon Berch, an insurance broker for Siegel Insurance, suggests that it’s not imperative that the very wealthy who have sizable insurance policies leave to heirs and still be able to afford skilled care without LTCI. He adds that LTCI is not for the poor who can’t afford LTCI premiums. Georgia’s Medicaid Community Assisted Services program operates under the Aged and Disabled Waiver to help frail older adults stay in their homes or communities and receive services there as an alternative to nursing homes. Those who fall between the two extremes of rich and poor are strongly encouraged to buy LTCI.

Because LTCI is expensive and premiums rise periodically, the decision about when to buy isn’t fixed. Raab believes the best age to purchase long-term care is between 50 and 60. Howard and Berch agree. Berch says this age group often looks to their aging parents, who are in their 70s or 80s and who often don’t have LTCI. The younger group wants to plan for future needs without becoming a financial burden on their children. If purchased at an older age, in the late 60s and 70s, the premiums are much higher even though it is likely that fewer years would be required.

Applicants with serious health problems, such as diabetes, cancer, kidney or heart disease, may be denied LTCI or may be accepted for coverage at higher premiums.

Raab mentions a new long-term care product that Howard calls a hybrid policy. For a total lump sum, an individual can purchase a paid life insurance policy with long-term care benefits. For example, the individual may invest $100,000 with no further premiums and the proceeds will be paid to the insured’s beneficiaries upon her death. If the policyholder needs long-term care, the entire $100,000 can be used for caregivers, leaving no money with the beneficiaries.

However, the insurance company provides another sum corresponding to the nominal amount of the original life insurance policy, to be used if necessary for further long-term care. In this example, the sum would be another $100,000. This insurance product is available to older policyholders in their late 70s who can afford to put a large lump sum into this special insurance plan.

Howard praises the hybrid policy that combines life insurance with long-term care, pointing out that the policyholder gets long-term care coverage along with designated heir life insurance if LTCI is not used. If only a portion of the life insurance is used for long-term care, the balance of the life insurance goes to the beneficiaries upon the death of the policyholder. Hybrid policies replace traditional long-term care policies for the elderly, whose premiums would be prohibitively expensive and would have hikes. It is worth noting that premiums are not required when the insured receives benefits following a claim.

Raab suggests another option. Long-term care policyholders can buy LTCI with benefits that will increase with inflation over the years and wait on them when needed. Gives an example: If a policy is purchased with an annual compound inflation increase of 3% with an initial monthly benefit of $3,750 ($125 per day), that monthly benefit the second year will increase to $3,863, then $3,979 the second year. third year and up to $4,893 in year ten. The inflation factor and the number of years to add to the benefits (20 years or lifetime) are determined at the time the policy is purchased.

Raab shares this caveat: Long-term care policies are indeed worth gold and can prevent financial ruin. A friend’s affluent parents, who lived in an assisted living facility, both developed dementia that required around-the-clock care at the same time. Because they didn’t have long-term care coverage, the exorbitant expenses were paid out of pocket. Both parents have needed care for almost four years. After one parent died, the other parent needed care for another three years. My friend and her siblings have seen their legacy disappear.

The cost of long-term care insurance depends on your age, health status, gender, amount of coverage, how long you wait before starting treatment, and marital status.

Howard candidly states on his website: Getting old is a part of life. At some point, most of us will need treatment. Maybe in a nursing home. Assisted living. Qualified care in our homes. Are you prepared?

Berch adds this solemn advice: Don’t become a financial burden on your children. Do your financial planning now!

Raab is practical about long-term care insurance. When it comes to insurance, something is always better than nothing!

The Ministry of Health and Welfare has finalized its budget for the 2024 fiscal year.

It expanded budgets to establish a regionally integrated essential health care system and ensure global competitiveness in the biomedical and digital health sectors.

The ministry said its fiscal 2024 budget won approval at a cabinet meeting on Tuesday. Total spending amounted to 122.45 trillion won ($92.58 billion), up 12.2 percent from 109.183 trillion won this year.

This is more than four times higher than the 2.8% increase in total public spending, reflecting the government’s intention to minimize the increase in total spending to ensure financial stability, while at the same time carrying out courageous investments in areas to which the country must give priority, such as support for the economy. socially vulnerable class and investments in the future, it says.

The ministry’s budget for next year has been formed with a focus on four key areas: strengthening the well-being of the most vulnerable, overcoming the declining birth rate, establishing a regionally integrated essential medical care system, and ensuring global competitiveness in the sectors of biological and digital health.

In the health and medical sector, it will carry out a pilot project to reorganize the emergency medical supply system in six regions so that all emergency patients can quickly receive final care in the event area, and a project to review the emergency medical system such as an on-call system that rotates for each disease among hospitals in the region so that surgeries and procedures can be performed at any time.

It will also set up regional emergency medical rooms in four regions for emergency patient transport, expand staff numbers at the central emergency medical center by six, and introduce another dedicated ambulance and medical helicopter for emergency patient transport. serious emergency.

Specifically, it increased the budget of the Emergency Medical Development and Support Program by 24 billion won, from 30.6 billion won this year to 54.6 billion won in 2024. of 6.2 billion won the pilot project aimed at reorganizing the emergency medical supply system and invested 5.1 billion won to establish a rotating on-call service for each major health emergency.

The ministry expanded the budget to support the emergency medical transportation system by 17 billion won, from 24 billion won to 25.7 billion won.

Increased the budget to support the operation of major emergency medical centers by 12.7 billion won, from 10.9 billion won to 23.6 billion won, and allocated a new budget of 10 billion won to manage large area medical emergency rooms.

Another primary policy has been the creation of a pediatric medical system that reassures children and parents.

First, the ministry will set up five 24-hour pediatric consultation centers to address blind spots in pediatric care, where parents can call at any time when their children are sick. Also, to support the operation of Moonlight Children’s Hospitals, 200 million won (US$151,200) will be donated each to 45 of these hospitals and will increase the number of pediatric emergency medical centers from 10 to 12.

To expand the infrastructure for treating critical pediatric patients, it will expand the number of public specialty treatment centers from 12 to 14, and develop five regional pediatric cancer primary hospitals for the treatment and recovery of pediatric cancer patients.

In particular, the government will provide a new training allowance of 1 million won per month for pediatricians and full-time doctors to promote pediatric medical personnel.

In detail, the Ministry has allocated 4.6 billion won for the pilot project of pediatric consultation centers and significantly expanded the budget for night and holiday care centers for pediatric patients from 200 million won this year to 4, 7 billion won in 2024.

The budget to support the operation of the specialized pediatric emergency medical system will increase from 5.2 billion won to 7.8 billion won. The budget for public centers specializing in the treatment of children will increase from 1 billion won to 6.1 billion won.

In addition, it has just formed a budget of 6.4 billion won for setting up a pediatric and adolescent cancer treatment system and 4.4 billion won to support training allowances for junior and full-time doctors.

It also included a budget for a paradigm shift in mental health focused on prevention. As a result, a budget of 53.9 billion won has been set aside for the National Mental Health Investment Project to ensure that all citizens can receive psychological counseling services when needed.

To expand mental health infrastructure, ministry expanded crisis intervention team in mental health care centers from 204 to 306 to respond to mental emergency patients at risk of self-harm and increased related budget from 75.2 billion won to 79.1 billion won.

The number of regional mental health emergency medical centers capable of responding to emergencies will also increase from 10 to 12, accompanied by a budget increase from 2.6 billion won to 3.6 billion won.

To support the economic burden of pregnancy and childbirth, it increased the budget for maternal and child health programs by 11 billion won, from 13.4 billion won to 24.4 billion won. This includes 6.3 billion won for mandatory fertility screenings and new support for assisted reproductive technologies that use frozen eggs for infertile women.

It will also implement policies to ensure the global competitiveness of bio- and digital healthcare. However, the budget to support the pharmaceutical industry was cut by 8.7 billion won, from 44.6 billion won to 35.9 billion won.

Conversely, the budget to enhance the competitiveness of the vaccine raw materials market increased by 5 billion won, from 7.9 billion won to 12.9 billion won. The budget for bio- and digital health R&D to secure future growth engines increased by 83.4 billion won, from 696.7 billion won to 780.1 billion won.

In addition, large-scale R&D budgets will receive new investments, including 49.5 billion won for Korea’s “ARPA-H” to solve national health challenges and 60.4 billion won for “Project Boston -Korea” for the Global Joint Research.

The 2024 budget, drawn up under difficult financial conditions, reflects the government’s concern about what it should prioritize,” said Kim Heon-joo, deputy minister for planning and coordination at the ministry. The ministry compiled the 2024 budget focusing on investments for the future. , such as protecting the truly vulnerable people in society, expanding essential medical care to protect people’s lives, overcoming the declining birth rate, and promoting strategic industries”.

The 2024 budget will be finalized later this year following the deliberations of the National Assembly.