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16 February 2017

Traveling Veterans - Seamless Care

This was actually written two weeks ago. I apologize if the time offset makes times and dates confusing. I've been writing, but things have been busy and complicated and I'm just now getting to actually posting.

My actual primary care appointment was this week, on February 14th. Six weeks from initial contact to actually talking to a doctor. 

More posts coming. 

I received a phone call from a (the?) Traveling Veteran Coordinator at the VA Medical Center here in Atlanta. This means that I'm cleared to receive medical and mental health care at the Atlanta VAMC while I'm here in Georgia, even though my "home" VAMC is in Wisconsin. There is such a thing as Seamless Care for Traveling Veterans, which is what I'm talking about here; you might find it useful to read this: https://www.va.gov/HEALTHBENEFITS/access/seamless_care.asp if you're not sure what I'm talking about.

To recap, this process started in early January. It took that long to get a primary care appointment.

I first called the Madison WI VAMC (my "home" VA hospital) to see what I needed to do in order to be seen/get a primary care yearly appointment at the Atlanta GA VAMC since that's where I am for now. They said call Atlanta, and Atlanta would be able to help.

I called the Atlanta VAMC and spoke to someone who said I needed to re-enroll in VA Healthcare-- bring in a DD-214, and completely reapply and reenroll, to get into primary care in Atlanta. Same person said that when I returned to Wisconsin, I'd need to take in a DD-214 and completely reapply and reenroll again there. That didn't sound right-- why would someone need to go through all of that?

I did some research and found https://www.va.gov/HEALTHBENEFITS/access/seamless_care.asp, Seamless Care for Traveling Veterans. Cool. Got all of the required information together, logged into MyHealtheVet, and sent it to my primary care team in Wisconsin via secure message. From there, they'd talk to the Traveling Veteran Coordinator in Atlanta and set things up. Except that's not what happened-- primary care said I needed to talk to someone in Eligibility in Wisconsin to set up a consult the next time I was in Wisconsin because I'd been detached from primary care, because it's been two years since my last primar care appointment.

No, that's not what https://www.va.gov/HEALTHBENEFITS/access/seamless_care.asp, Seamless Care for Traveling Veterans says, and what I'm trying to ultimately do is set up that yearly appointment with primary care so I can reattach. So I call Eligibility in Wisconsin.

I explain to Eligibility in Wisconsin that I am a traveling veteran (now that I know the term) and I am in Georgia, and since there exists a program for traveling veterans, I'd like to get a primary care appointment through the Atlanta VAMC. The person there doesn't really know about Traveling Veterans, but promises to find out and puts me on hold while she goes and talks to a supervisor. The result of that conversation is that Atlanta's full of shit, I neither need to bring a DD214 or reenroll, and Wisconsin is going to contact Atlanta to get things et up.

This week (two weeks later) the Traveling Veteran Coordinator from Atlanta calls, lets me know everything is set up for me to be seen in Atlanta. She can't set up a primary care appointment, but she does contact primary care and they'll contact me. I let TVC know that I am working night shifts, and that when someone does call they should call in the afternoon-- as in, after 1200.

Wednesday this week: Primary care from Atlanta calls at 1100 and leaves a voicemail with a name and number and extension. I try calling back three times-- at 1526, 1543, and at 1619-- and each time get that person's voicemail followed by a message saying I cannot leave a message because the mailbox is full.

Thursday this week: Primary care from Atlanta calls at 1119 and leaves a voicemail with the same name, number, and extension as yesterday. I call at 1435, 1441, 1444, 1450, and 1621 (I'm reading these times from my phone) and each time, the call goes straight to voicemail and I get the same message that the mailbox is full.

Friday this week: I haven't slept much, because I'm beyond irritated that a) Atlanta VAMC keeps calling when I've told them I'm asleep and b) I'm expecting the phone to ring this morning and I want to catch the call when it comes in. It doesn't. I try calling the same extension again, and again get the voicemail message that the mailbox is full.

This is the third try, them calling me, and in the past when someone has tried to call me three times without reaching me from the VA, they check a box on a form that I'm unreachable and that's the last I hear from the VA. Can you say "fall through the cracks yet again"?

Ok Google. Directions to the Atlanta VA Medical Center in Decatur Georgia. We're going to find/see the Patient Advocate's office.

It's about an hour's drive from where I am to the Atlanta VAMC. A highlight of the trip is that it took me right past Stone Mountain (yes, that Stone Mountain). While I'm on my way to the Atlanta VAMC, primary care calls again but I don't answer; I'm driving and I can't call back anyway because they don't answer.

After a couple of misturns getting into the parking structure, I'm in the VA hospital. I find an information desk, ask where to find the Patient Advocate, and a few steps later I'm there talking to an Iraq veteran (who is from the PA's office), shaking her hand, and briefing her on me being a traveling veteran, having jumped through the hoops, and been contacted by the right person only at times when I couldn't answer and that I'm not able to leave a voicemail back.

I mention the person from primary care that I'm trying to reach, and the PA recognizes her by first name immediately. I don't work for the VA, but I can imagine that the PA knowing your name in a bad way that well can't be good.

PA tries calling primary care person, gets voicemail.

PA emails primary care person, with read receipt enabled so we'll know when/if primary care person sees the email-- primary care person reads it almost immediately, which means she's at her desk. Primary care person calls PA (might be other way around). Pleasantries exchanged. PA reminds primary care that the veteran drove an hour to the VAMC because he couldn't get in touch with anyone. I get to talk to primary care, who does not apologize but says she's been very busy because she's just back from leave. I make it a point to remind her to learn how to delete old voicemails.

An appointment is made for me, finally, on February 14th at one of the satellite primary care clinics.

This process started January 3, when I first went in person to a Vet Center here-- the Vet Center offered no help or assistance with getting a primary care appointment at the hospital/a clinic (they just shrugged and said "primary care? nope not us"). Now, the VA will say that took less than 30 days for me to get an appointment, so everything's cool-- but in reality it took all of this for me to get scheduled for an intake appointment at a primary care clinic:

* One ~80 mile round trip to a Vet Center
* A certain amount of time doing my own research online
* Two phone calls to my "home" VA medical center, one involving a supervisor
* One phone call to the Atlanta VAMC which was no help
* One secure message to my home primary care team which was no help
* One or more calls from Wisconsin to Atlanta
* One call from traveling veterans coordinator in Atlanta
* Three calls to me from primary care in Atlanta
* A shitton of calls from me to primary care in Atlanta trying to reach them
* An email and a call from the Patient Advocate's office to primary care
* One ~100 mile round trip to the Atlanta VAMC at my expense

AND THIS IS JUST TO GET AN INTAKE APPOINTMENT AT A PRIMARY CARE CLINIC.

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I didn't complete my bachelor's degree, but I did work in technical support for eight years. Someone says they're too busy to clean out their old voicemails because they just came back from leave, I call bullshit. It's this person's job to schedule primary care appointments for people. That they responded immediately to a email from someone in the Patient Advocate's office tells me that they're at their desk and can hear the phone when it rings. It's 2017, and you can see the caller ID of who's calling, at least the number-- how many people in the 608 area code is someone at Atlanta primary care in contact with, ESPECIALLY people that they are supposed to be calling and getting in touch with? You'll talk to the Patient Advocate, but you won't talk to the patient?

No one in the Patient Advocate's office was particularly surprised that I'd hopped in my truck and been willing to drive in two hours of Friday in Atlanta traffic just to get in touch with someone. The PA I talked to knew the primary care person by first name. Ugh.

I could have let it go, said fuck it.

Primary care did call again late on Friday afternoon when I was awake, but I was already almost to the VAMC by then. If I'd not been in the truck driving, I might have heard the phone ring-- and then answered and talked to the person and got the appointment set up. Maybe. If I'd missed the call I'd still have had no way to call back, because the primary care person's voice mail was full-- so the next thing that would happen is primary care would note that they'd called me three times and I'd not answered, and the process would stop there.

It's happened to me before. Primary care knows (because I've told them) that I work nights, they ignore the note, call in the morning, and then give up after they've made three calls.

Since I was already "detached from primary care" I'd have stayed that way. I didn't finally get a primary care appointment because the Patient Advocate helped, or because Eligibility in Wisconsin helped, or because the traveling veterans coordinator helped-- none of them would have done anything at all if I hadn't been a pain in the ass and kept calling and writing and showing up in person.

It's the same as when I got myself off the streets and found an apartment on my own. My limit of two years in VA transitional housing would have been up in November 2014, and when I was evicted in April 2014 they still hadn't even filled out the paperwork for HUD-VASH-- a process that takes months to years. There never was any post-homelessness follow up.

It's the same as the last Vet Center I talked to, where the counselor said "you're fine, you don't need to come back for anything" even when I was pretty clear that yes I actually did.

THIS IS WHAT IT MEANS TO FALL THROUGH THE CRACKS.

-----

It's Sunday afternoon now.

Friday night I didn't sleep well after my trip to the VAMC in Atlanta (I hadn't slept well Thursday night with all of this happening, either). Most of Saturday, and to some extent even today, I'm not feeling all that well. PTSD is really kicked in. I can't concentrate on anything for more than a few minutes at a time. I'm jumpy, any little noise sets my heart racing. My fuse is really short, I'll go from zero to pissed off in half a second. I was already anxious and depressed, and now it feels a lot worse.

I am trying to find the right words to explain just how draining it is to have to go through all of this nonsense with the VA. I'm not a runner, but maybe this works. Imagine the finish line at a marathon, where it's getting dark and most of the participants have long since finished the race and gone home. There's that one person who is down to their very last breath of energy when they finally cross the line, and they collapse as soon as they do. I've never run a marathon, so I can't say that's exactly how I feel, but I can imagine it feels something like that. I'm exhausted in a way that will take time to recover from.

Think about that for a minute. I'm that exhausted from setting up an intake appointment.

Chances are that at the intake appointment I'll talk to yet another nurse or physicians assistant with a clipboard who hasn't looked at my records and will ask me all of the same questions I've answered a hundred times before. Maybe they'll take my pulse and temperature and blood pressure and have me stand on a scale, take some blood samples, have me pee in a cup. There won't be therapy, there won't be treatment, but I'll feel exhausted after the appointment too.

-----

Is it worth it, going through all of this? Lately I wonder, but it is true that I need to do something to take care of myself-- no one else is going to look after me. I'm pretty self sufficient, most of the time, but if I get physically sick or injured, or if I need to talk to someone from mental health, it's a lot easier if I have a place to go to. So I need the VA, because I don't have an alternative. This-- getting everything arranged in Atlanta-- is necessary. There are things I still want to do with my life, I'm not done yet.

It really bothers and concerns me, how complicated this all has been. I'm pretty damn stubborn, and on a good day I can figure some shit out. I've got a lot of experience with this stuff now, so I know to look at the VA's website. I know to use MyHealtheVet to send written requests for things, so there's a record that I asked. I know to ask to speak to supervisors, and I know to talk to the Patient Advocate.

If I'm going through all of this shit just to get an intake appointment at primary care, knowing what I know, how bad is it for other veterans? How many of us just give up after talking to the first person from the VA that says "no" or hands us a bundle of red tape to unravel on our own? How many brothers and sisters get that response from the VA and then start sliding downhill from there? How many brothers and sisters do we lose every day, just because the energy needed to ask for and get what they needed from the VA was more energy than they had?

 

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