Facilitating Healthcare for Veterans Residing in Rural South Carolina and Florida: What is Community Care?

There are many programs currently offered to military youth and families. However, US military Veteran participation in Cooperative Extension programs has not been well documented across all Extension program areas. Infrequent targeting of the military population for Extension programming may be due to difficulty reaching a heterogenic and widespread population.¹ However, to better reach and serve this population, Extension Agents must understand the needs and barriers rural Veterans and their families face. This publication describes the most common challenges rural Veterans and their families face in accessing healthcare and how the United States Veterans Health Administration (VHA) has been trying to reduce health disparities with programs such as community care.

Introduction

Access to health care for Veterans and their families in rural areas is complex but critical for good health. Some of the needs reported in the literature are transportation issues to Veteran Affairs (VA) medical centers, limited access to specialty providers in rural communities, issues related to severe weather conditions and a lack of rural road infrastructure in the region, geographic proximity to the nearest VA medical center, and distance measured in time.² Research has shown that Veterans’ age, health, and ability to perform activities of daily living were the most common factors influencing distance as a barrier to accessing care.³

VHA reaches approximately 9 million enrolled Veterans. With 172 VA medical centers, 1,321 healthcare sites, and 1,138 outpatient care facilities,⁴ VHA is the most extensive healthcare system in the United States. The VHA healthcare system covers qualifying Veterans for appointments with their primary care providers and visits with cardiologists, gynecologists, and mental health providers. Veterans can get medical equipment such as hearing aids and batteries, crutches, blood pressure monitors, canes, and walkers, among other supplies, prosthetics and medications.⁵

Even though VHA has been making efforts to reduce health disparities for Veterans living in rural areas across the United States, many Veterans still face barriers to accessing healthcare. Understanding these barriers and identifying community care as a health resource option for Veterans will increase the confidence of Extension Agents and healthcare workers in working with the Veteran population for health resource navigation. Extension Agents can refer Veterans to the VA healthcare system for enrollment and guidance on eligibility for community care. This assistance can potentially improve access and equity of healthcare services for rural Veterans.

In 2006, the VA Office of Rural Health (VA-ORH) was established to support 2.7 million Veterans enrolled in the VA healthcare system in rural communities.⁶ Compared to urban communities, rural residents have higher poverty rates, older residents, limited access to high-speed internet, and experience greater geographic distance and accompanying transportation barriers. Additionally, rural residents have fewer physicians, hospitals, and other health-related resources and poorer health status than those in rural communities.⁶

Veteran Populations in Florida and South Carolina by the Numbers

According to the VA-ORH, 4.7 million Veterans live in rural and highly rural areas.⁶ Florida ranks 3rd in the nation with a Veteran population of 1,492,000.⁷ Of those, 167,816 (11%) live in rural areas, and more than half of the Veteran population (53%) is over the age of 65. In contrast, 397,649 Veterans live in South Carolina, ranking 18th in the nation.⁸ Of those, 125,318 (32%) are in rural counties,⁷ and almost half (45%) of the Veteran population in South Carolina is 65 years of age and older.⁹

What is Community Care?

Recent research revealed some of the challenges faced by rural Veterans accessing healthcare, such as distance to a VA medical center, geography, cost, transportation, and lack of understanding of the military culture within others.^10,11 The VA community care program is a benefit that helps eligible rural Veterans receive healthcare from providers in their community when the VA cannot provide the care needed. The VA covers the cost of the services provided by the community provider. Some examples of situations where the VA cannot provide healthcare needed for a Veteran include maternity care, local psychiatric services, and other specialty care such as orthopedics, dentistry, or dermatology. Community care is approved for Veterans who meet specific eligibility requirements, do not have access to the local VA healthcare system, and have specialist needs. In most circumstances, the VA must first authorize the service, and VA staff members will make all eligibility determinations. Additionally, Veterans must be enrolled in the VA healthcare system or, at minimum, qualify for enrollment to access community care benefits.¹² Information on eligibility criteria is available on the VA Community Care website.

Veterans need to meet one of the following six criteria to be eligible to receive community care:

1. The needed service, such as maternity care, is not offered at a VA medical facility.
2. The state or territory does not have a full-service VA medical facility (i.e., Alaska, New Hampshire, Hawaii or Guam, American Samoa, Northern Mariana Islands, or the US Virgin Islands are automatically eligible).
3. The Veteran’s average driving time to a VA medical facility exceeds
   – a 30-minute drive time for primary care, mental health, and non-institutional extended care services, and,
   – a 60-minute average drive time for specialty care.
4. When the VA can’t schedule an appointment for a needed service within a specific timeframe
   – within 20 days for primary care, mental health care, and non-institutional extended care, or
   – within 28 days for specialty care.
5. When the VA medical referring doctor and Veteran agree to see a specialist (such as an oncologist) outside the VA healthcare system to better serve the care needed.
6. If the local VA service provider doesn’t meet the VA quality care standards.¹³

A community care provider must be in the VA care network. The Find VA Locations website can help locate in-network providers. Veterans and those assisting them with healthcare resource navigation can find additional information about how to locate in-network providers and other details on the Community Care website or call the contact center at (877) 881-7618 to receive direct assistance.

Summary

Extension professionals are positioned to serve various stakeholders in their counties and develop and implement successful programmatic outreach when they are aware of needs that affect the well-being of specific populations. Through education about the community care program, Extension Agents can be an invaluable health resource to qualifying Veterans and their families by assisting with resource navigation to identify VA websites and other community programs to help reduce barriers and travel time to healthcare providers.

Definitions

The US Department of Veterans Affairs (VA) is a federal agency that provides benefits, healthcare, and cemetery services to eligible US military Veterans and administers programs benefiting Veterans and their families. It offers education opportunities and rehabilitation services and provides compensation payments for disabilities or death related to military service, home loans, pensions, and burials.¹⁴

The Veterans Health Administration (VHA) provides primary care, specialized care, and related medical services and social support to US military Veterans. It is the largest integrated healthcare system in the country.¹⁵

A Veterans Affairs hospital is any VA-owned, staffed, and operated facility providing acute inpatient and/or rehabilitation services.¹⁶

A Veterans Affairs medical center is a VA point of service that provides at least two categories of care (inpatient, outpatient, residential, or institutional extended care).¹⁶

Veterans Affairs community care is a program for Veterans who meet specific requirements to see healthcare providers from the community. The VHA pays for this service.¹⁷

Veterans Affairs community care service providers are part of the Veterans Affairs healthcare network. They provide eligible Veterans and their beneficiaries with timely, high-quality health care.¹⁸

References Cited

1. Rowe D. Serving those who served: How can Extension reach U.S. military Veterans? Journal of Extension. 2014;52(6):13–16. https://tigerprints.clemson.edu/joe/vol52/iss6/3.
2. Juretic M, Hill R, Luptak M, Rupper R, Bair B, Floyd J, Westfield B, Dailey NK. Reaching out to older Veterans in need: the Elko Clinic demonstration project. The Journal of Rural Health. 2010;26(4):325 –332. doi:10.1111/j.1748-0361.2010.00302.x.
3. Buzza C, Ono SS, Turvey C, Wittrock S, Noble M, Reddy G, Kaboli PJ, Reisinger HS. Distance is relative: unpacking a principal barrier in rural healthcare. Journal of General Internal Medicine. 2011;26:648–654. doi:10.1007/s11606-011-1762-1.
4. Veterans Health Administration. Washington (DC): U.S. Department of Veterans Affairs; 2023 [accessed 2023 Oct 23]. https://www.va.gov/health/aboutvha.asp#.
5. VA Health Care. Washington (DC): U.S. Department of Veterans Affairs; 2023 [accessed 2023 Jul 14]. https://www.va.gov/health-care/.
6. Office of Rural Health: About Us. Washington (DC): U.S. Department of Veterans Affairs; 2023 [accessed 2023 Feb 2]. https://www.ruralhealth.va.gov/aboutus/.
7. Fast Facts. Largo (FL): Florida Department of Veterans Affairs; 2021. https://floridavets.org/our- Veterans/profilefast-facts/.
8. Von Nessen JC. The economic impact of South Carolina’s military community: a statewide and regional analysis. Columbia (SC): University of South Carolina, Darla Moore School of Business; 2022 June. https://scdva.sc.gov/sites/scdva/files/Documents/Economic%20Impact%20Final%20June%202022.pdf.
9. National Center for Veterans Analysis and Statistics. State summaries: South Carolina. Washington (DC): U.S. Department of Veterans Affairs; 2017. https://www.va.gov/vetdata/docs/SpecialReports/State_Summaries_South_Carolina.pdf.
10. Schooley BL, Horan TA, Lee PW, West PA. Rural Veteran access to healthcare services: investigating the role of information and communication technologies in overcoming spatial barriers. Perspectives in Health Information Management/AHIMA, American Health Information Management Association. 2010 Apr;7(Spring):1f. https://www.ncbi.nlm.nih.gov/pubmed/20697468.
11. Gale JA, Heady HR. Rural vets: their barriers, problems, needs. Health Progress. 2013 May-Jun;94(3):48–51. https://www.ncbi.nlm.nih.gov/pubmed/23789468.
12. Community Care. Washington (DC): U.S. Department of Veterans Affairs; 2023 [accessed 2023 Jul 7]. https://www.va.gov/COMMUNITYCARE/programs/Veterans/General-Care.asp.
13. Veterans Health Administration. Veteran community care eligibility. Washington (DC): U.S. Department of Veterans Affairs; 2019 Aug 30 [accessed 2023 Oct 24]. Fact Sheet. IB-10-1188-COMMUNITY CARE. https://www.va.gov/COMMUNITYCARE/docs/pubfiles/factsheets/VA-FS_CC-Eligibility.pdf.
14. U.S. Department of Veterans Affairs (VA). Washington (DC): U.S. Government, USAGov; 2023 [accessed 2023 Jul 14]. https://www.usa.gov/agencies/u-s-department-of-Veterans-affairs.
15. Veterans Health Administration. Washington (DC): U.S. Department of Veterans Affairs; 2023 [accessed 2023 Jul 10]. https://www.va.gov/health/.
16. Veterans Health Administration. VHA Handbook 1006.02: VHA site classifications and definitions. Washington (DC): U.S. Department of Veterans Affairs; 2013 Dec 30. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970#:~:text=A%20VA%20hospital%20is%20any,%2C%20or%20institutional%20extended%20care).
17. The Veterans Community Care Program: Background and Early Effects. Washington (DC): Congressional Budget Office; 2021 Oct [accessed 2023 Oct 25]. https://www.cbo.gov/publication/57583.
18. Community Care: Provider Overview. Washington (DC): U.S. Department of Veterans Affairs; 2023 [accessed 2023 Jul 14]. https://www.va.gov/COMMUNITYCARE/providers/index.asp.