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Long-term TBI care lacking, report says

Three years after rehabilitation for traumatic brain injury, eight of 52 veterans interviewed faced significant unmet medical, mental health and career-assistance needs, and most of the patients had no sign of recent case management, according to a Department of Veterans Affairs report released Thursday.

“While case management has improved, long-term case management is not uniformly provided for these patients,” states the report from VA’s Inspector General. “In some cases, significant needs remain unmet.”

Investigators looked at medical and compensation records for veterans who had received in-patient care after being injured in Iraq and Afghanistan and were discharged from the military in 2004.

In the short term, investigators found that 52 patients initially had similar outcomes when compared to people with traumatic brain injuries receiving care in civilian facilities. In the long term, however, the veterans’ care needed improvement.

Patients with traumatic brain injuries often need more assistance in finding help because of the cognitive, emotional and behavioral issues associated with head injuries. That also can place extra stress on family members who often take on the task of providing care.

The Senate Veterans’ Affairs Committee asked for the report in the wake of testimony from families about feeling abandoned after veterans left VA care facilities.

Investigators concluded that veterans had received VA health care if they had a primary care visit at a VA center, were hospitalized or if they had a social-work or case-management progress note from February 2007 to January 2008.

Investigators also personally interviewed 41 of the veterans about changes in their personal lives, as well as medical or education benefits they received.

They found that six of the 52 had received recent care at the rehabilitation centers from which they had been released in 2004.

And eight of the 52 had no evidence of follow-up at all within VA. Of those, five had mild functional impairments, and one had a severe chronic disability.

Investigators found 22 patients received non-VA care, mostly funded through Tricare. But 10 patients had difficulty obtaining primary or specialty care, did not know what was available to them, could not navigate VA’s system or needed supportive counseling.

Two of the 10 had evidence of VA case management, and seven of the 10 are not in school or employed.

Five patients received compensation benefits before discharge from rehabilitative care, but 37 patients waited between 10 weeks and 132 weeks for compensation after they were discharged.

VA officials have announced plans to contact all Iraq and Afghanistan veterans to ensure their needs are being met and that they have a case manager if they need one, beginning with 17,000 injured or ill vets.

The IG’s office called that a “positive step,” but expressed concern that not all veterans released after inpatient care receive proper case management.

VA officials concurred with the results of the investigation, but said they have a “much more comprehensive program” in place that affects troops discharged since 2004.

“We believe we now have systems in place to ensure that all veterans with TBI are being followed as their clinical needs require,” wrote Michael Kussman, VA’s deputy under secretary for health, in response to the investigation.

Kussman also said the IG did not provide a clear definition of “long-term case management,” but outlined some steps VA has taken to provide better care, such as a working group formed in April that will look at long-term care across all disciplines.

“I believe VA is arguably the leader in establishing this ideal, and we will continue in the development of the best model of care management for VA facilities,” Kussman wrote.