Within the United States today, approximately 16.5 million people are military veterans, from those who served in World War II to those who were active more recently, at home and abroad (U.S. Census Bureau, 2022). Given the size of this population, case managers in every care setting are likely to encounter veterans, including individuals whose health and functioning potentially have been impacted by their military service, even decades ago. Therefore, as part of intake and assessment, case managers should ask every client (known as "patients" in some care settings) whether they are currently serving in or have ever served in the military. Such information can have a significant impact on care coordination and care provision.
A case in point is an individual in his early 70s who told a professional case manager that he had been diagnosed with a heart condition and Parkinson's disease. His age and health status triggered a thought in the case manager's mind, and she asked whether he had served in the military. "Yes, in Vietnam," the man replied. Knowing the link between Parkinson's disease and exposure to the herbicide known as Agent Orange used during the Vietnam War (Parkinson's Foundation, 2022), the case manager told the man that his military service could possibly have contributed to his medical conditions. If so, she continued, the man could be eligible for compensation and other benefits from the Department of Veterans Affairs (VA).
With assistance from the case manager, the man and his family completed and submitted the required forms to apply for veterans' benefits. After his military service was confirmed, the veteran began receiving health services from a local VA hospital and was also determined to be 100% eligible for compensation benefits due to his service-related disability. This money paid for adaptations to his house, including installation of an elevator, and the purchase of a power chair. Before receiving these benefits, the man had been paying out-of-pocket for boutique medical care and could no longer safely stay in his home because it was not accessible.
By taking a person-centered approach, the professional case manager looked beyond the current medical episode to see the entire individual: a Vietnam-era veteran who service directly affected his health today. Although thorough assessments are always essential in case management, they are particularly important when addressing the needs of a specialized population such as veterans to ascertain the potential impact of their military service on their long-term health and functioning.
One particular area to assess is "adaptive functioning," a term used to describe how individuals cope with their life demands including how they care for themselves and interact with others (Mitchell, 2018). An example is a veteran with a traumatic brain injury (TBI), which was indicated in a psychosocial evaluation provided by the VA to a professional case manager working with this veteran. Based on the evaluation, the case manager understood this individual's level of functioning; his short-term memory was impaired by the TBI and therefore he needed repetition when learning new tasks. This understanding also informed how the case manager should be providing information and support to this individual. For example, when the veteran asked for a referral to a specialist, the case manager knew that only providing information on how to access providers would be insufficient. Instead, the case manager sat down with the individual at a computer and together they went through the process of finding a provider. This seemingly straightforward example holds an important lesson about understanding adaptive functioning. Otherwise, there is an increased risk of veterans getting lost in a fragmented health care system in which it is difficult to manage care cohesively.
Case managers in every care setting need to be aware of the resources available through the VA, which lists on its website (https://www.va.gov/service-member-benefits/) a comprehensive menu of services covering health care, disability, education, and more. Importantly, case managers should not assume that a veteran is covered by TRICARE, the health care program for uniformed services members, retirees, and their families. Among veterans, only those who have retired from the military with 20-plus years of service are eligible for TRICARE. Otherwise, all eligible veterans can receive medical benefits through the Veterans Health Administration (VHA).
Case managers can learn more about VA Outreach programs in their specific area by reaching out to their local county Veterans Benefits Agency (VBA) by phone or online. More information is also available through VA Care Management and Social Work (https://www.patientcare.va.gov/caremanagement.asp), with programs that address a variety of clinical needs of wounded, injured, and ill service members, veterans, family members, and family caregivers.
Unemployed And Homeless Veterans
Within the veteran population, there is a particular challenge when serving those who are both unemployed and homeless. According to the U.S. government's 2022 Point-in-Time Count, the number of veterans experiencing homelessness was 33,126, a decrease of 11% from January 2020 (http://VA.gov; U.S. Department of Veterans Affairs, 2022). Behind such statistics there are human stories, each a reminder of the importance of empathy and advocacy in serving the needs of each individual.
A professional case manager was working in a public health clinic screening for sexually transmitted diseases when an individual in his 60s disclosed that he was both a veteran and homeless. Although these two factors were not directly related to the services being provided at the clinic, the case manager took on a broader advocacy role. She explained to this individual that he could be eligible for services from the VA. The man adamantly refused, saying he wanted nothing to do with government services. The case manager recognized this attitude as not being uncommon among some Vietnam-era veterans who felt unsupported by their government and by society.
Respecting the man's autonomy and right to self-determination, as stated in the Code of Professional Conduct for Case Managers (Commission for Case Manager Certification [CCMC], 2018), the case manager suggested other community-based resources that might fit his needs, such as a nearby homeless shelter. Contacting the facility, the case manager confirmed that the shelter had a vacant bed and provided that information to the man. As this example shows, if an individual is homeless and a veteran, case managers need to advocate from the context of both circumstances and provide information and access to resources that exist for both communities. Combining them may be the most effective strategy for addressing the individual's needs while respecting their experiences and perspectives.
Although veterans are a specialized population, each is an individual. Through thorough assessment, empathy, listening, and a desire to advocate within the context of each person's lifestyle and choices, case managers can make a difference in helping these individuals who served attain the care and treatment that they deserve and desire. That is why, one of the first questions asked of every individual case managers encounter should be: "Are you a veteran, and if so do you know what services are available to you?"
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