AUDIOLOGY SERVICES
To enhance services provided to high priority veterans in a timely manner, the following eligibility criteria have been established for audiology services: • Complete Audiological Services, INCLUDING Hearing Aids:

• 0% Service Connection for impaired hearing, ear condition, tinnitus
• 10-100% Service Connection for ANY condition
• Ex-POW
• Purple Heart Recipients
• Aid and Attendance
• House Bound
• Hearing Evaluation Only:
• Service Connection for ANY condition other than impaired hearing or any ear condition Not Eligible for Audiologic Services:
• Non-Service Connected (NSC) Veterans
• Exception: Acute ear disease/problem needing evaluation by an otologist

Consultation requests are made via electronic consultation request. Patients are seen on a first-come first-served basis.  Specific questions and concerns may be directed to the Chief, Audiology and Speech Pathology Service who may be reached at extension 15209 at the Audie L. Murphy Division or 699-2100 extension 3099 at the Frank M. Tejeda Outpatient Clinic.

SPEECH PATHOLOGY SERVICES
Speech Pathology Services may be obtained via electronic consultation request to Speech Pathology from a physician or physician extender. Specific questions and concerns may be directed to the speech pathologist at extension 15209 at the Audie L. Murphy Division, extension 14589 at Extended Care Therapy Center (ECTC) or extension 74-2287 at the Kerrville Division.

COMMUNITY NURSING HOME CARE PROGRAM (CNHCP)
Nursing home care may be provided in the community at VA expense in a VA approved contract nursing home. Duration of Placement is dependent on veteran's eligibility. Patients must be medically stable and without infection before transfer to the nursing home. A seven-day supply of prescriptions and any appropriate durable medical equipment must accompany the veteran when transferred. Prompt completion of nursing home forms is essential to expediting placement of the patient.
Contract nursing home patients may not be transferred to a nursing home on Saturdays, Sundays or holidays as the administrative support for authorization, admissions, and travel is not available. Patients imminently terminal will not be transferred to a nursing home. Veterans discharged to a nursing home are under the care of the private nursing home physician and only appointments for specialty care should be made at the time of discharge. All routine podiatry and medical care is per the nursing home physician. A social worker and the community health nurse provide
follow up while the veteran is on VA contract placement. A GEC Referral is made through the Unit Discharge Planning Conferences or by contacting the veteran's social worker for assistance with community nursing home placement.

COMMUNITY REFERRAL PROGRAM
Veterans are eligible for home skilled services if required to avoid hospital stay or manage needs care needs after hospitalization. Veterans in receipt of Medicare or having a service-connected disability may also be eligible for additional services. Please contact the veteran’s social worker to refer a patient for home care services.

COMMUNITY RESIDENTIAL CARE PROGRAM
This supervised residential care program is coordinated by Social Work Service and is intended to help veterans maintain maximum independence in functioning in the least restrictive environment. Room, board, quality of life activities, and moderate supervision are provided in San Antonio and Kerrville area homes and assisted living facilities. Sponsors or care providers are approved by STVHCS. The veteran becomes a member of this new “family group” and pays the home sponsor/assisted living facility for services provided according to DVA established rates. Veteran’s health care needs in the program are continually evaluated and case managed by a VA social worker. Hospital staff members make referrals to the program through the social worker on the primary care team or by calling 699-2165 to inquire about program specifics. The Enhanced Community Residential Care Program is a new program available to those 50% - 100% service-connected veterans who are at risk of nursing home placement, but can be managed at the assisted living level of care. Eligible individuals pay for their room and board at an area assisted living facility and the VA pays for the cost of their personal care. Referrals for this program are made through the Social Worker on the Primary Care Team or by calling 699-2165.

THE HOME BASED PRIMARY CARE PROGRAM
The Home Based Primary Care Program provides primary care services in the home to complex and or frail patients who are usually homebound. Appropriate referrals include patients who have multiple, interacting; chronic illnesses, need palliative care for a terminal illness, or require case management for a specific medical problem. These patients are assigned to a HBPC physician as their PCP. Home Based Primary Care is provided in San Antonio and Kerrville. An interdisciplinary team of physicians, nurses, physical therapists and a dietician provides care in both programs. In addition, short term patients can be admitted to HBPC for “focused care”. These patients remain assigned to their current PCP while HBPC staff care for acute problems such as wound care, medication management and or physical therapy. A new program offers care coordination, disease management and home tele-health technology to provide close monitoring of veterans with Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Hypertension, Coronary Artery Disease, and Diabetes who have increased need for hospitalization or urgent care visits.  In general, veterans must live within a 40 minute drive from either medical facility. Program hours are Monday-Friday, 8:00 a.m. to 4:00 p.m., except holidays. Arrangements can be made for patients requiring wound care services during evenings and weekends. Send consults to Extended Care Service electronically requesting HBPC. For assistance with the referral, contact the social worker assigned to your team, or call 949-3071 in San Antonio or 1-2961 for Kerrville to obtain more information.

EXTENDED CARE THERAPY CENTER (ECTC)
ECTC is a specialized nursing facility designed to care for residents requiring restorative and rehabilitative nursing care services. Discharge is anticipated to the home or community or referrals to other extended care programs, as appropriate. Included are residents requiring extensive rehabilitative care for a limited time as well as patients who may be self-sufficient in most ADL areas but require moderate care in some ADLs. Length of stay is three to nine months. Patients may also be admitted for wound care, intravenous therapy, specialized treatments (such as hyper baric therapy and radiation therapy, if living a long distance away) or for palliative care on a selective basis, after meeting hospice criteria (i.e., prognosis less than 6 months). Intermediate or acute medical care needs are provided by hospital admission with return to ECTC when the patient is stabilized, provided inpatient care does not exceed 30 days.

KERRVILLE TRANSITIONAL CARE CENTER (KTCC)
KTCC is located at the Kerrville Division and offers many of the services that are offered in ECTC: (1) wound care; (2) low intensity rehabilitation, (3) palliative care, (4) dementia specialty (5) Spinal Cord and (6) respite care. Patients that are best served by ECTC are not accepted to KTCC; all patients are
considered for admission through the electronic process. Admission to KTCC1, the Dementia Specialty Care Unit (DSCU) requires admission to the unit prior to noon; all other admissions to KTCC should be scheduled for the patient to arrive by 2 PM. Discharge planning starts upon admission to provide the best level of care for the NHC patient.
 

THE FREDERIC C. BARTTER GENERAL CLINICAL RESEARCH CENTER (GCRC)
The FREDERIC C. BARTTER GENERAL CLINICAL RESEARCH CENTER (GCRC) is a highly specialized inpatient and outpatient unit which provides a mechanism and resources for performing quality clinical research in a controlled environment. Funded by NIH, this is a joint venture between the STVHCS and the UTHSCSA. Veteran and non-veteran subjects of all ages may be admitted to the GCRC under a research protocol, which has been approved, by “The Institutional Review Board (IRB) and the VA Research and Development Committee”.

GERIATRIC EVALUATION AND MANAGEMENT
Both ALMMVH and KD have a multi-disciplinary evaluation team consisting of a geriatrician, nurse, social worker, clinical pharmacist, and geriatric psychiatrist.

GERIATRIC CONSULTATION SERVICE
Selected outpatients who require an interdisciplinary approach to care may be eligible for primary care in the geriatric clinic. Referral for patients 80 years and older are appropriate for care in the GEM clinic.
Services can be requested through the electronic consult indicating GEM. The Internal Medicine Clinic will not follow these patients concurrently.

GERIATRIC RESEARCH, EDUCATION, AND CLINICAL CENTER (GRECC)
The GRECC was established to improve the care of older veterans through a comprehensive program integrating innovative research, education, and clinical activities. The GRECC focuses on an array of multi-disciplinary interests in geriatrics and gerontology at the South Texas Veterans Health Care System, Audie L. Murphy Division, and its affiliated medical institutions. The GRECC is composed of three interrelated components: research, education, and clinical. The research component of the GRECC highlights studies in metabolism/endocrinology, nutrition, and oral health/dentistry. With the large Hispanic population in San Antonio, investigations of ethnicity as a variable in health care for the elderly are included in the GRECC research program. The education component of the GRECC features the development of didactic training programs in pathophysiological, psychosocial, and cultural aspects of aging. A postdoctoral fellowship exists for training of geriatric medicine, psychiatry and dentistry fellows. A medical residency rotation in geriatrics and continuity of care clinic expose trainees to the clinical principles of geriatrics necessary for the practice of general internal medicine. Innovative programs also address patient and family caregiver education, health promotion, and disease prevention. The clinical component of the GRECC focuses on the evaluation of models of health care delivery to elderly veterans. Clinical demonstration projects are carried out in cooperation with the extended care treatment programs in the hospital.

HOSPITAL SMOKING CESSATION PROGRAM
The STVHCS Smoking Cessation Program is available to all veterans. Inpatients and outpatients of the
hospital and its clinics are eligible to participate. The didactic portion of the program, co-facilitated by an interdisciplinary staff team, consists of three one-hour classes held the first third Tuesday of each month (exept for December). This program series begins the first Tuesday of each month, exept for holidays or when otherwise rescheduled. Support groups and community resource referrals are also available. Nicotine replacement patches are available on VA formulary. Eligibility for patches and other medication is restricted to veterans. Prescriptions are also limited to a 30-day supply at a time. Any VA physician may prescribe and may contact the applicable pharmacy (inpatient/outpatient) if there are questions. Discussion is ongoing about the use of other medication that might support patients' cessation efforts. Once protocols are established, information will be disseminated. To refer a veteran to the program submit an electronic consult with the following information and then forward to the Quality Management office:

• Name
• Address
• Social Security Number
• Telephone #

The referral section should contain a brief smoking or other tobacco use history, the patient’s understanding of how tobacco use affects his/her health, and a statement about their level of motivation to quit.  For veterans who must travel long distances to San Antonio for appointments, every effort will be made to refer them to a program more convenient to their home. You are encouraged to contact Quality Management at extension 16510 for assistance with these referrals.
 

MOVE PROGRAM – MANAGING OVERWEIGHT/OBESE VETERANS EVERYWHERE
This is a national program developed by the VHA and NCP striving to address the morbibity and mortality associated with overweight/obesity. It is multidisciplinary, comprehensive, individually-tailored, and evidence-based, derived from NHLBI/NIH “Guidelines on Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.” Goals include improvement in quality of life and health status, decrease/delay in the onset/occurrence of obesity-related chronic disease, and encouragement of patients’ sense of personal responsibility and empowerment to affect health status changes. Housestaff involvement in the program consists of screening patients for overweight/obesity (BMI>25), assessing patients for MOVE! Inclusion and exclusion criteria, addressing weight as a health concern with patients, and offering MOVE! Enrollment. Facilitation of enrollment for eligible patients is made through a consult to Nutrition (Attention: Debra Pierce, RD) or by contacting Bert Lindo, LMSW, at ext. 16049. Initiation into the program begins with completion of a questionnaire, the results of which generate personally tailored handouts regarding diet, exercise and behavioral issues. Then, individualized goals are established, and the patient proceeds through the different program levels, based on weight loss progress. Supportive resources include close monitoring of patient’s progress through weekly phone calls with ongoing education regarding exercise, diet, and behavioral modifications (Level 1); addition of multidisciplinary group sessions led by nutritionists, physical therapists, and psychologists (Level 2); pharmacotherapy (Level 3); trial of brief residential treatment (Level 4); and bariatric surgery (Level 5). More information regarding MOVE! Can be found on MOVE! Web site at vaww.move.med.va.gov
 

OUTPATIENT PARENTERAL THERAPY REVIEW BOARD
This is a multi-disciplinary review board established to ensure appropriate use of parenteral therapy for outpatients and to assist with the implementation of such care. Referrals should be addressed to the Chair, Outpatient Parenteral Therapy Review Board, ext. 15951, or via facility mail (119).
 

PALLIATIVE CARE PROGRAM/HOSPICE
According to the World Health Organization, “Palliative Care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other physical symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families.” Hospice is palliative care given to patients with a life expectancy of less than six months.  The Palliative Care Team includes a Medical Director, Palliative Care Fellows (in medicine, psychology, social work, nursing and chaplain) and a Palliative Care/Hospice Nursing Coordinator. They are available for consultations for:

• Patients with no cure for their disease requiring symptom control
• For patients with a short life expectancy needing guidance with end of life decisions
• Placement for hospice services at home or as an inpatient

Notify the Palliative Care/Hospice Coordinator @ 713-4593 and initiate an electronic consultation for hospice or palliative care.

PSYCHOLOGY CONSULTATION
Psychology Service staff psychologists, interns, and postdoctoral residents provide a wide range of psychological services to veterans in programs throughout the medical center. Diagnostic testing, psychotherapy, and consultation services are available for all eligible veterans. Staff psychologists are part of the interprofessional treatment teams with PTSD, Inpatient/Outpatient Psychiatry, Psychiatric Day Treatment, Liaison Psychiatry, Substance Abuse, Geriatrics, Neuropsychology, Pain Management, Internal Medicine, HIV, Spinal Cord Injury, Employee Assistance and Sleep Disorders Programs. Informal consultation is always available to speaking with the psychologist associated with these programs. Formal consultation requests can be sent electronically through CPRS addressed to “Psychology-Other”. They will be reviewed by a senior psychologist and assigned to the most appropriate team/person. Questions regarding consultations or other psychological services can be answered by calling the Psychology Service Office at 617-5121.
 

RECREATION THERAPY ACTIVITIES FOR PATIENTS
Therapeutic recreation activities are prescribed for patients in the hospital on medical, surgical and psychiatry units by consultation (SF 513). Comprehensive evaluation and treatment are also provided to veterans in the Extended Care Therapy Center, Spinal Cord Injury Center, Day Treatment Center, and Substance Abuse and Day & Home/Based Clinics. Recreation Therapy Service staff provides coverage seven days a week, including evenings, weekends, and holidays. A wide variety of general recreation activities are offered daily for patients to attend.  Recreation Therapy activities encompass a variety of modalities which include but are not limited to: games, sports, athletics, music, dance, hobbies, community re/integration, physical recreation, spectator events, special therapy programs, wheelchair athletics, special events, creative communication, social recreation, leisure education.
 

SPECIALIZED PSYCHIATRY PROGRAMS
The Day Treatment Center: a partial-hospitalization program which is designed for the treatment of patients who require assistance in stabilizing their condition to an improved quality of life, to decrease frequency of hospitalization, and to encourage participation in their psycho-social and vocational rehabilitation. This program features individualized treatment plans for patients with more chronic, longterm mental illness who require specialized treatment programs. The Day Treatment Center is located at the Villa Serena Psychosocial Rehabilitation Program and is in operation 5 days per week. (Monday through Friday.)

Healthcare for Homeless Veterans (HCHV) Program has three components:

• Homeless Chronically Mentally Ill (HCMI) Program, which provides outreach to homeless veterans and either makes referrals to the medical center or places veterans in halfway houses;
• HUD-VASH (VA Subsidized Housing) Program which provides long-term housing and case management to those veterans who have successfully completed the HCMI Program; and
• SSA/VA Joint Outreach Initiative which expedites the homeless veterans’ claims for SSI/SSA benefits.

THE POST TRAUMATIC STRESS DISORDER CLINICAL TEAM (PCT)
This program began at this facility in 1988 and is designed to aid veterans and their families in dealing with PTSD. This program has expanded and through its multidisciplinary team efforts, has developed specific group counseling for the veterans, family counseling, and a recently initiated spouse’s therapy group for wives of veterans suffering from PTSD symptoms. Please identify referrals that are returning Iraqi or Afghanistan veterans as they get priority treatment.
 

THE SUBSTANCE ABUSE TREATMENT PROGRAM
The Substance Abuse Treatment Program (SATP) provides a variety of services. The Substance Abuse
Residential Rehabilitation Program (SARRTP), consists of the intensive 28-Day Program and 14-Day Relapse Prevention Track. In both programs veterans reside at Villa Serena, the Psychosocial Resource  Center, and travel by van to and from the hospital for 8 hours of therapeutic activities Monday through Friday. In addition, there is the Aftercare Program, designed as follow-up for patients who have completed the SARRTP, a Dual Diagnosis program for individuals with substance abuse problems in addition to psychiatric issues, and a regular Outpatient Program. The Substance Abuse Research Program provides outpatient treatment studies for veterans through federal and private funding. All detoxification is provided by Inpatient Psychiatry.
 

MENTAL HEALTH OUTPATIENT SERVICES (MHOS)
Psychiatry Service offers a wide variety of outpatient treatment modalities in the Mental Health Clinic, a
24-hour Psychiatric Urgent Care Unit (triage) for psychiatric emergencies, a psychophysiology lab for the treatment of stress, and a consultation liaison service for all medical/surgical units.

VISUAL IMPAIRMENT SERVICES TEAM (VIST) PROGRAM
This program is aligned under the Chief of Staff and based at the Audie L. Murphy Division. Services are provided to veterans residing in the areas served by all three Divisions. The Team provides comprehensive rehabilitative services to veterans with severe visual impairments. Referrals should be made by consult to the social worker on the nursing unit or outpatient clinic. Referrals can also be faxed to the VIST Coordinator at 210/949-3325. The VIST Coordinator can also be contacted by telephone at 210/949-3523. The VIST office is located in Room 105, Eye Clinic area, and is open five (5) days a week (Monday through Friday) from 8:00 a.m. to 4:30 p.m.
 

WOMEN VETERANS PROGRAM
A full time Women Veterans Program Manager (WVPM), a certified Women's Health Care Nurse Practitioner and advocate for the women veterans is available to assist women veterans within the STVHCS, WVPM performs if requested: health care assessments (which can include breast and pelvic
exams), provides education, facilitates the scheduling of outpatient appointments if the exams are not appropriate or indicated at that time, and addresses other women's health issues on an individual basis. The WVPM can be reached via pager 713-5967 or VA ext. 14605 weekdays, 7:30 a.m. - 4:00 p.m. Women veterans who have been sexually traumatized in the military have access to counseling from the Women Veterans Psychological Trauma Team through consult to Outpatient Psychiatry or through the Vet Center. Law now requires that all veterans, male and female, be assessed for Military Related Sexual Trauma (MST). Upon initial presentation to a primary care clinic or at the Women’s Clinic, a screening form is given to the patient, which asks questions identifying MST. If the results are negative, the form is returned to the nurse who enters the data via the Clinical Reminder for MST. If the results are positive the screening tool is given to the provider who provides referral and satisfies the Clinical reminder.  Referral is accomplished by giving the patient the Veterans Sexual Trauma Referral List and by adding the counselor’s name as an “additional signature” at the completion of the note. Any questions regarding this process should be directed to the Women Veterans Program Manager. A full range of women’s health care services are available through authorized fee services. For further information, call the Women’s' Veterans Program Manager.  Mammography, according to the American Cancer Society Guidelines, can be scheduled through Radiology after breast examination by an inpatient or VA outpatient provider.  Routine women's health care and management for gynecological problems may be obtained for eligible veterans by requesting an appointment to the Women's Health Clinic at the FTOPC.  Urgent gynecological problems--patient must be seen within 24-48 hours.
All new women patients entering the STVHCS are referred for gender specific care through the WVPC. Inpatient--WVPC should be consulted to evaluate the patient and facilitate further GYN evaluation. If the WVPC is not available, contact the GYN Chief resident at University Hospital.  Outpatient--The patient may be scheduled urgently with the Women's Health Clinic dependent on the urgency of the problem by contacting the nurse in charge at 699-2100 ext 3084 or 2124.  Obstetric Services—are available for the pregnant veteran through contract services. Contact the Women Veterans Manager to arrange care. If there are no emergent problems, an appointment can be made with the WVPM at FTOPC. Contact the nurse in charge at 699-2100 ext. 3084 or ext 3084 if the WVPM is not available. Emergent obstetric problems will be handled in the same manner as gynecological emergencies.