More space in Caldwell, Twin Falls. More telehealth. What VA recommendations mean for Idaho vets
Report to AIR Commission, released in March, could bring big changes to how and where the VA prioritizes veteran health care services
The Boise VA Medical Center is in downtown Boise, blocks from the Boise campus of St. Luke’s Health System. The VA hospital cares for veterans and made the unprecedented move to care for civilians during the COVID-19 pandemic. (Audrey Dutton/Idaho Capital Sun)
Idaho’s veteran population is changing.
They’re aging. They’re becoming more diverse, as more women, people of color and LGBTQ service members enter the military. And they’re seeking different kinds of treatments, such as long-term and mental health care, in different parts of the state.
New recommendations to overhaul and modernize health care that the U.S. Department of Veterans Affairs provides to those who have served were sent to the Asset and Infrastructure Review (AIR) Commission last month. They show that more veterans are expected to enroll in VA services in most areas of Idaho, and that mental health care, long term assisted living care and outpatient services are in high demand with a trajectory that’s not expected to change anytime soon. Increased demand for inpatient and surgical services was also noted for the southwest and northern part of the Gem State.
Compiling the recommendations was no easy feat.
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The VA conducted a nationwide assessment of its health care system, analyzed extensive internal data, interviewed leaders at every VA medical center across the country, held listening sessions with veterans and consulted with veterans service organizations.
The ultimate goal? Building a 21st century health care network with the right facilities, in the right places, to provide the right care for all veterans, including underserved and at-risk populations, according to the VA.
“This is not something that’s going to happen in the next week or months, but these recommendations that they have made will come to fruition over the next number of years,” said David Wood, the Boise VA Medical Center director.
The report emphasized the changing dynamics of how to place services near population centers where the most veterans can access care — and building partnerships with other health care providers while investing in telehealth offerings for locations like rural Idaho.
“We strive to achieve this through different avenues to meet rural health (veterans’) needs,” said Bret Bowers, spokesperson for the Mann-Grandstaff VAMC in Spokane, in an email statement.
For example, veterans can access care in Sandpoint through a rural health clinic five days a week, and the VA operates a mobile medical unit that goes to different locations in Idaho to improve access, he said. There are also programs through the VA’s Office of Connected Care that can provide veterans with technology like iPads to set up and access telehealth services, Bowers said.
What happens next with the VA’s recommendations?
President Joe Biden, the U.S. Congress and the AIR Commission — a bipartisan body whose members are appointed by the president and approved by Congress — will review the recommendations and determine whether they will be accepted and implemented, according to the VA’s website.
Veterans are encouraged to attend public hearings the AIR Commission will host as it travels around the country to visit VA facilities during this review period.
After that, the AIR Commission will transmit the recommendations, with any necessary changes, to Biden. The Biden administration will then determine whether to submit those recommendations to Congress for funding consideration. That process could take several years.
The recommendations that affect Idaho’s three local VA markets fall into two of the VA’s Veterans Integrated Service Networks, or regional systems of care: VISN 19, which covers eastern Idaho, and VISN 20, which covers southwestern and North Idaho.
Here are a few changes outlined in those reports that veterans in each area of the state should know about.
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Proposed changes that would affect eastern Idaho veterans
Veterans in eastern Idaho largely rely on care from the Pocatello and Idaho Falls VA clinics and the Salt Lake City VA Medical Center, which could see major renovations and upgrades under the VA’s recommendations to the AIR Commission.
SALT LAKE CITY MARKET BY THE NUMBERS Projected veteran enrollment increase: 1% Projected increase for inpatient mental health services: 7.8% Projected increase for long-term care: 43.7% Estimate to maintain facilities and services as status quo without upgrades: $18.8 billion VA recommendation with changes: $19.7 billion
SALT LAKE CITY MARKET BY THE NUMBERS
Projected veteran enrollment increase: 1%
Projected increase for inpatient mental health services: 7.8%
Projected increase for long-term care: 43.7%
Estimate to maintain facilities and services as status quo without upgrades: $18.8 billion
VA recommendation with changes: $19.7 billion
For the Pocatello clinic, the report recommends adding more home-based primary care services, which allows veterans to receive care in their own home for things like chronic illness or mobility issues that might make it harder to get to a doctor’s office.
It also recommends fully staffing the physical therapy services at the Pocatello clinic for the first time.
“The Pocatello (clinic) was built with dedicated space for physical therapy, but it has not been activated due to lack of funding for necessary full-time (employees),” the report said. “Total market veteran demand for physical therapy is projected to increase significantly, so staffing the program will reduce the need to rely on physical therapy services in the community.”
The report also details extensive upgrades for the Salt Lake City VA, which was first built in 1949 and was last renovated in 1988.
The upgrades include adding a new tower for new hospital beds, as well as building a new standalone nursing home to help with the increased demand for long-term care and decrease the reliance on that kind of care from private companies in the area.
Proposed changes that would affect southwestern Idaho veterans
Wood said many of the recommendations outlined in the report to the AIR Commission for the Inland South Idaho Market, which includes medical facilities in Salmon, Twin Falls, Mountain Home, Boise, Caldwell and eastern Oregon, largely follow goals that his market is already actively working toward.
Some of the biggest changes in the southern Idaho market will include the expansion of the Caldwell VA Clinic and the closure and relocation of the Twin Falls VA Clinic.
INLAND SOUTH IDAHO MARKET BY THE NUMBERS Projected veteran enrollment increase: 2.7% Projected increase for inpatient mental health services: 4.7% Projected increase for long-term care: 32.8% Estimate to maintain facilities and services as status quo without upgrades: $8.65 billion VA recommendation with changes: $9.5 billion
INLAND SOUTH IDAHO MARKET BY THE NUMBERS
Projected veteran enrollment increase: 2.7%
Projected increase for inpatient mental health services: 4.7%
Projected increase for long-term care: 32.8%
Estimate to maintain facilities and services as status quo without upgrades: $8.65 billion
VA recommendation with changes: $9.5 billion
To better distribute care across the Treasure Valley’s VA facilities, the report recommends expanding the outpatient clinic in Caldwell. The addition of physical therapy and audiology services in Canyon County will alleviate some of the demand for those services at the Boise VA, the report said.
“We are actually in the process right now of designing and planning to build over this next year a new Caldwell community-based clinic that will be double the size of the current clinic,” Wood said. “It … plays into the recommendations that were delivered to the commission. Almost all the recommendations that were made related to our market are really where we are going and where we have been going for some time.”
He said the VA hopes to open the expanded Caldwell facility in 2023.
Developing partnerships for primary care and telehealth options for veterans who use VA facilities in the Ontario/Weiser areas would also help decrease demand for services at the Caldwell clinic and the Boise VA, the report said.
In Twin Falls, the community-based outpatient clinic will be relocated to a larger building to expand primary care options and mental health services, Wood said. The current facility is undersized at 4,200 square feet, and the land it sits on, which is owned by the city, prevents it from being renovated and expanded at its current location. The renovation will include new, state-of-the-art equipment that could help recruit and retain doctors and nurses to the area, the report and Wood said.
“We haven’t gotten far enough along that we actually would know what the location (will be),” he said. “I would anticipate that it would be over twice the size of the current clinic and expand the current services that are there as well, like with the Caldwell (clinic), it would continue to expand the number of telehealth-type services that are offered there.”
In Boise, the recommendations call for expanding the dental clinic at the Boise VA. The demand for those services is expected to increase by 55.6% by 2029, and there is limited capacity to meet the growing demand without expansion, the report said.
The report said significant changes could be coming to the Salmon VA clinic in central Idaho. Due to fewer veterans enrolling there than what is required for a full community-based outpatient clinic, it recommends the Salmon VA clinic be reclassified as a smaller clinic with fewer services. The report said the VA will continue to study the sustainability of the site.
Proposed changes that would affect North Idaho veterans
Many of the significant recommended changes to the Inland North Market affect Spokane’s Mann-Grandstaff VA Medical Center or the Walla Walla Medical Center, although the VA also operates facilities in Coeur d’Alene, Lewiston and Sandpoint.
INLAND NORTH MARKET BY THE NUMBERS
Projected veteran enrollment decrease: -0.9%
Projected increase for inpatient mental health services: 8.2%
Projected increase for long-term care: 61.3%
Estimate to maintain facilities and services as status quo without upgrades: $14.3 billion
VA recommendation with changes: $14 billion
The report recommends the Walla Walla Medical Center reduce primary care and mental health services, “which may result in the VAMC being reclassified as a (community-based outpatient clinic),” the report said. “VA has experienced an ongoing challenge recruiting and retaining clinical staff.”
Some of the specialty care veterans have received in Walla Walla may be transferred an hour away to Richland, Washington, where there is a larger veteran population that uses the VA.
For Spokane’s Mann-Grandstaff VA Medical Center, the report suggests establishing more strategic collaborations with other local hospitals and clinics for inpatient and surgical services, and discontinuing those services in Spokane due to low demand.
The report also recommends consolidating the administrative teams from Walla Walla and Spokane into one team to save money.
The report recommends adding audiology services to the Coeur d’Alene facility.
“Opening audiology services in Cd’A Idaho would improve access for many veterans and reduce the number of veterans requesting community care due to drive time to the Spokane VAMC Audiology Clinic,” Bowers said in an email. “ It would further improve the timeliness of care offered here at the Spokane VAMC Audiology Clinic.”
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