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Since the announcement regarding the possible closure of the Canandaigua VAMC and the loss of its services to the veterans in the Finger Lakes there has been overwhelming support for turning the recommendations around and avoiding this atrocity this is but one of the letters that have been received locally and sounds a resounding cry to stop the insanity.

Please find attached a guest essay on the part of Virginia Tyler Homsy of Canandaigua. Virginia Tyler Homsy, CHE is the former VP of Strategic Planning and Business Development for Thompson Health and a former project director for the Healthcare Association of New York State. Ms. Homsy attended the meeting at the VA last Wednesday. This is an interesting and thought-provoking essay and was also published in the Daily Messenger.

VA Closing Bad for Patients, Bad for the Community

There is no doubt about it: healthcare is expensive in 2003. 

Having worked on a number of healthcare planning projects at state and local levels, I know how hard it can be to design efficient services for a community.  However, if we only look at the costs to be saved now, we lose sight of the cost to our Veterans and the community. We have to consider quality of care, efficiency, and community need.

As I understand it, the Canandaigua VA has a well documented history of high quality inpatient and outpatient care.  Their accreditation scores are excellent. Patient satisfaction scores are well above average. Quality, then, is not the issue. 

Next is the question of operational efficiency.  The VA has created a plan to streamline use of its campus for program efficiency.  Whenever possible, the VA already makes space available to the community, including making unused buildings available to the school district and other community partners.  The staff is doing all it can to make creative, cost-efficient use of its space.

That leaves the questions of community need.  The need for services is changing.  The service area is becoming more urban.  The population is aging.  We have an increased number of Veterans with the most recent war.  Thus, the need for services is also growing. According to VA statistics, the Canandaigua facility provides services to 41% of eligible Veterans in Livingston, Monroe, Ontario, Seneca, and Wayne County.  Canandaigua provides more care to local Veterans than any of the other facilities in the region.

The Canandaigua VA provides long term care, substance abuse treatment, military sexual assault treatment, and primary care (among other services).  This facility is known for its mental health services, a vital component of care for Veterans with emotional and physical disabilities.

What will happen, if these services are removed from Canandaigua?  If beds are closed and services moved to Bath, Batavia, Syracuse and/or Buffalo, how will patients respond? The short answer is: not well. 

Recently I reviewed the medical literature on Veteran’s access to care, and the potential consequences of centralizing services in other parts of the state.  The research all points in the same direction: Veterans need care that is consistent, well-funded, and locally provided.  Let’s look at each of these issues in turn:

CONSISTENT CARE IS NECESSARY FOR HEALTH AND SAFETY

Disabled Veterans without consistent care risk homelessness and greater illness. The Agency for Healthcare Research and Quality says that physical illness, substance abuse, and mental illness are all barriers to working.  Persons suffering from these disabilities are more likely to work at lower paying jobs.  That makes them less likely to be able to afford housing.  The Rand Corporation has found that homeless Veterans are less likely to access treatment and support. Services that treat disabled Veterans are vital to their health and self-sufficiency.  A disruption in services could cause a surge in homelessness, and those persons would not be likely to seek care elsewhere.

Veterans with mental illness and addictions are at risk for criminal behavior. The Bristol Observatory found that VA patients with substance abuse and mental illness were substantially more at risk for arrest than the general population.  Interventions with medical and social support help to decrease the risk of criminal activity.  Providing VA mental health and substance abuse services is a vital part of Veteran and community safety.

Continuity of care is directly related to per-patient spending. The Canandaigua VA facility has higher costs than other facilities.  Yet research shows that higher per-patient spending on outpatient mental health care is an important factor in the continuity of care.  Patients who do not have continuous, consistent healthcare actually use more services but have poorer health.  Cost per patient may not be the issue. The questions to ask are: is care coordinated, and are outcomes consistent? At Canandaigua, the answer is yes.

CENTRALIZATION DOES NOT CUT COSTS OR IMPROVE CARE

If Veterans do not have a local VA care site, they will use more community-based and emergency services.  Research indicates that Veterans who do not have care provided by a VA facility are more likely to have unplanned urgent care visits and an increased rate of community hospitalization.  A 2002 study at the Wayne State University School of Medicine found that “disadvantaged individuals lacking support and alternative treatment settings” use psychiatric emergency services to meet basic needs.  Patients using only Emergency services do not do as well over the long term.  Primary care through a local VA site helps patients to respond better, and to stay healthy for longer.

Federal and state budget costs have already put a strain on local health and social service providers.  Without VA services to support this population, the local community would bear the burden of providing their care. In the long run, closing the Canandaigua VA is not going to improve cost efficiency.  Costs will increase at other VA facilities, and local hospital costs will certainly increase.

PATIENTS NEED CARE IN THE COMMUNITY WHERE THEY LIVE

VA Patients are not likely to travel long distances for care. According to a 2003 study in the journal Addictive Behavior, distance is absolutely associated with accessing care. How much does distance matter?   Patients living 50 miles or more from after care are 260% less likely to access services than those living within 10 miles of care. In fact, 60% of patients who lived more than 25 miles from services did not obtain aftercare at all. Veteran’s services need to be local, and the population needs a way of accessing them.  Recently a local Vet said: “Four days a week I come here for treatment.  I don’t want to go to Buffalo four times a week, it’s impossible.”

Healthcare planning is highly complex, but in this case the risks far outweigh the benefits. If the Canandaigua VA closes, our local Veterans risk increased drug and alcohol abuse, illness, homelessness and criminal activity.  They face a reduction of primary care health services and less chance for self-sufficiency.  Our public services and private hospitals risk increases in cost, client volumes and emergency service usage at a time when they are already overburdened. Perhaps most importantly, our community risks turning its back (once again) on the very persons to whom we owe great respect and gratitude.

These are untenable risks for our community.  We need the Canandaigua VA to remain open, for our existing Vets and those who will need us in the future.

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Last modified: August 16, 2003