Alabama
and the
U.S. Department of Veterans Affairs

• General:  The Department of Veterans Affairs (VA) offers a wide variety of programs and services for the nation’s 24.3 million veterans.  In 2006, about 5.3 million people were treated in VA health care facilities, 3.6 million veterans and survivors received VA disability compensation or pensions, nearly 600,000 used GI Bill education benefits and more than 2.4 million owned homes purchased with GI Bill home loan benefits originally valued at $236 billion.  About 100,000 veterans and family members were buried in VA’s national cemeteries and 360,000 headstones and markers were provided for veterans’ graves worldwide.

VA spent more than $1.4 billion in Alabama in 2006 to care for about 418,000 veterans who live in the state.  That same year, 89,739 veterans and survivors received disability compensation, dependency and indemnity compensation, or pension payments in Alabama.  VA provided 9,141 veterans, reservists or survivors educational benefits through the GI Bill; 50,707 owned homes with active VA home loan guarantees originally valued at $1.5 billion.  Alabama veterans held more than 21,000 VA life insurance policies valued at approximately $237 million.  In 2006, 464 were interred in the Ft. Mitchell and Mobile national cemeteries.

• Health Care:  One of the most visible of all VA benefits is health care.  VA has 153 hospitals, 895 ambulatory care and community-based outpatient clinics, 209 Vet Centers, 135 nursing homes, 47 residential rehabilitation treatment programs and 92 comprehensive home care programs.  To improve patients’ ability to access care, VA has changed from a hospital-based system to a primarily outpatient-focused system over the past decade.  Veterans will make 55 million outpatient visits to VA health care facilities this year.

In Alabama, VA operates major medical centers in Birmingham and Tuscaloosa.  Additionally, VA’s Central Alabama Veterans Health Care System provides health care in the Montgomery and Tuskegee areas.  In 2006, VA facilities in Alabama had 7,732 inpatient admissions and provided nearly 948,000 outpatient visits.

The Birmingham VA Medical Center (VAMC) is an acute tertiary care facility providing a full range of patient care services, with state-of-the-art technology, as well as education and research.  The medical center provides comprehensive health care through primary care and tertiary care in medicine, surgery, psychiatry medicine and rehabilitation, neurology, oncology, dentistry and geriatrics.  To provide primary care services in rural areas of north Alabama, VA operates community-based outpatient clinics in Anniston-Oxford, Bessemer, Dothan, Decatur-Madison, Gadsden, Huntsville, Jasper and the Shoals area.  The Birmingham VAMC is the southeastern referral center for blind rehabilitation.

The Tuscaloosa VA Medical Center provides primary care, extended care and mental health care services.  The Tuscaloosa VAMC has a rehabilitation program for veterans with addictive disorders, post-traumatic stress disorder (PTSD) and other serious mental illnesses who require additional structure, supervision, and intensive rehabilitation to address multiple and severe psychosocial deficits.  The program consists of a 21-bed substance abuse residential rehabilitation program, a 15-bed PTSD residential rehabilitation program and a 12-bed Compensated Work Therapy transitional residence. The Tuscaloosa VAMC has a combat veteran program, a home-based primary care program and a care coordination program which includes telemedicine services.

The Tuscaloosa VAMC is also one of the leading facilities in VA in customer satisfaction, wait times, and preventive health measures such as cancer screenings and outcomes of care for patients with diabetes mellitus and hypertension.  In addition, the Tuscaloosa VAMC is a model among VA facilities in the treatment of returning Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans.  OIF/OEF veterans are assigned to one primary care provider who specializes in the care and treatment of these veterans.

The Central Alabama Veterans Health Care System (CAVHCS) was formed in 1997 as a result of the merger of the Tuskegee and Montgomery medical centers and community-based outpatient clinics in Dothan, Ala., and Columbus, Ga.  The East (Tuskegee) and West (Montgomery) campuses are 40 miles apart.  The East Campus is located on 170 acres of land in a rural setting adjacent to the historic Tuskegee University and Moton Field, home of the Tuskegee Airmen.  The West Campus is located on 52 acres in a residential neighborhood adjacent to city school property and approximately five miles east of downtown Montgomery.  CAVHCS has 160 nursing home beds and a 43-bed homeless domiciliary on the East Campus.

In Mobile, the VA outpatient clinic provided care during more than 60,000 outpatient visits in primary care, mental health, and some specialty clinics in 2006.  The Mobile Outpatient Clinic is affiliated with the University of South Alabama medical school.  The clinic serves veterans in four counties along Alabama’s Gulf Coast.  Care is also provided through the clinic to veterans in Pensacola and Florida’s Panhandle.

• Post-Conflict Care:  VA has launched special efforts to provide a "seamless transition" for those returning from service in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF).  Each VA medical facility and benefits regional office has a point of contact to coordinate activities locally to help meet the needs of these returning combat service members and veterans.  In addition, VA increased the staffing of benefits counselors at key military hospitals where severely wounded service members from Iraq and Afghanistan are frequently sent.  Once home, recent Iraq and Afghan veterans have ready access to VA health care, which is free of charge for two years following separation for any health problem possibly related to wartime service.  Some 205,000 veterans from the Global War on Terror have sought VA health care since returning stateside, about one-third of the total number of men and women leaving military service.

In Alabama, more than 5,300 active duty service members and veterans of the Global War on Terror sought VA health care in 2006.  At Birmingham, 2,061 OIF/OEF veterans were cared for; 1,198 visited Tuscaloosa; and 2,049 were seen at the Montgomery and Tuskegee campuses.  Many veterans from the conflict in Iraq and Afghanistan have visited VA counseling centers in Birmingham and Mobile.  These community-based Vet Centers serve as an important resource for veterans who, once home, often seek out fellow veterans for advice or help transitioning back to civilian life.

• Geriatric Care:  Long-term care is a critical issue for America’s veterans.  Approximately 39 percent of living veterans are at least 65 years, compared with 12 percent of the general population.  The challenge to care for these 9.5 million men and women is met through a spectrum of home and community-based programs such as home-based primary care, homemaker and home health aide services, home respite and hospice and adult day care health.  VA also provides home and domiciliary care for veterans who can no longer be safely maintained in non-institutional settings.  Additionally, VA conducts nationwide research on the causes and treatment of Alzheimer’s disease and other dementias and funds 21 geriatric research, education and clinical centers, each focusing on a major geriatric problem.

In Alabama, 38,435 veterans aged 65 and older sought medical care from VA in 2006.  With the average age of veterans continuing to increase, end-of-life care is becoming more needed.  Birmingham has initiated for physicians and other health care providers an ongoing education curriculum on end-of-life care.  The Birmingham VAMC has become a model for palliative care and has a 12-bed palliative care unit called Safe Harbor.  Dr. Amos Bailey, founder of the nationally recognized Balm of Gilead, is director of the program.

At the Tuscaloosa VAMC, the demand for long-term care continues to increase.  A variety of inpatient programs are available, including dementia, psycho-geriatric, skilled nursing home, transitional medical care, short-term evaluation, long-term rehabilitation and end-of-life and palliative care.  The Tuscaloosa VAMC has four nursing home care units helping veterans achieve and maintain optimal levels of functional independence.  The care units emphasize a safe environment;  preserve the individuality, dignity, and quality of life; provide programs that are founded and developed in a sound knowledge base of geriatrics and long-term care; and facilitate the veteran’s return to a community setting, if possible.

A variety of outpatient programs are available: homemaker and home health aide services, purchased skilled home health care, hospice care, respite care, community nursing homes, care coordination home tele-health (a program designed to monitor patients with diabetes from home using telecommunications technology), and home-based primary care (HBPC).  The HBPC program provides medical care by VA physicians, nurses, and other health care professionals to homebound, severely disabled, chronically or terminally ill veterans whose conditions make them unsuitable for management in outpatient clinics.  The Geriatric and Extended Care Department's Office of Care Coordination coordinates care for combat veterans, veterans with terminal illnesses, and veterans with special care needs such as traumatic brain injury, spinal cord injury and blind rehabilitation an visual impairment services team.

At CAVHCS, the Geriatrics, Extended Care and Rehabilitation Service has expanded its care to include initiatives that encompass the whole person.  The Alzheimer dementia unit allows staff to focus on the special needs of patients with dementia.  The addition of the therapeutic wandering area, a park-like setting complete with a waterfall, allows patients with dementia access to outside activities with their families.  Another initiative is the adoption of the Eden Alternative concept that has led to the creation of a home-like environment using plants, pets and familiarization techniques.  CAVHCS also provides home-based primary care for veterans unable to access primary care due to frailty.

In 2002, VA selected Birmingham as the site of a Geriatric Research, Education and Clinical Center (GRECC).  The GRECC is a center of excellence designed to increase the basic knowledge of the aging process, to share that knowledge with health care providers and trainees and to improve the overall quality of care for elderly patients.  Each GRECC in VA has a specific research, educational and clinical focus.  The Birmingham GRECC focuses on genito-urinary disorders such as urinary incontinence and mobility problems, both major issues for the elderly.

• Research:  To provide the highest quality of health care to the nation’s veterans, VA sponsors a world-renowned research and development program that addresses some of the most difficult challenges facing medical science today, such as aging, vision loss, women’s health, Gulf War illnesses, diabetes, bioterrorism and hepatitis. VA researchers led the way in developing the cardiac pacemaker, the CT scan, magnetic source imaging and improving artificial limbs.  More recently, injuries sustained by armed forces engaged in current deployments have further increased the long-standing emphasis on VA research on limb loss; prosthetics and tissue replacement; traumatic brain injury; spinal cord injury; and mental health issues including post-traumatic stress disorder.  The quality of the research and relevance to the veteran population remain the determining factors in deciding what studies to fund.

The VA funds research projects at the Birmingham medical center in biomedical rehabilitation, and health services research and co-operative studies.  Research areas include cardiology, endocrinology, pulmonary disease, nephrology, hematology, infectious diseases, oncology, neurology, neurosurgery, immunology and rheumatology.  Studies range from understanding the mechanisms responsible for disease to a number of co-operative studies evaluating new therapy.

The research program at the Tuscaloosa VAMC offers volunteer participation in several experimental studies.  The primary mission is to promote greater scientific, social and medical discoveries to improve the quality of life for a growing veteran population in the local community.  Currently, there are ongoing studies investigating new medications in the treatment of psychotic symptoms associated with dementia, bipolar disorder, post-traumatic stress disorder, major depression and schizophrenia.

• Disabilities and Pensions:  Not all military service related issues end when people are discharged from active duty.  About 2.7 million veterans receive monthly VA disability compensation for medical conditions related to their service in uniform.  VA pensions go to about 330,000 wartime veterans with limited means.  Family members of about 527,000 veterans qualify for monthly VA payments as the survivors of disabled veterans or pension recipients.

VA's Montgomery Regional Office serves veterans and their survivors in Alabama who are seeking VA financial benefits.  In fiscal year 2006, the Montgomery Regional Office processed 14,245 disability compensation claims, including 4,448 veterans applying for the first time and 9,797 cases where veterans reopened a claim, usually to seek an increase in their disability rating level for higher payments.  More than 3,000 Alabama veterans participated in VA’s Vocational Rehabilitation and Employment program in 2006.

• Homeless:  Nearly one-quarter of all homeless adults are veterans, and many more veterans who live in poverty are at risk of becoming homeless.  VA is the only federal agency that provides substantial hands-on assistance directly to the homeless.  It has the largest network of homeless assistance programs in the country.  More than 15,000 residential rehabilitative, transitional and permanent beds are available for homeless veterans throughout the country.  VA aggressively reaches out to veterans on the street, conducts clinical assessments, offers needed medical treatment, and provides long-term shelters and job training.  More than $265 million is dedicated to specialized homeless programs to assist homeless veterans, including grants and per diem payments to more than 400 public and non-profit groups.

All VA medical facilities in Alabama have homeless programs.  The Birmingham VAMC homeless program can house 50 homeless veterans in three contracted halfway houses.  Additionally, the facility has a Compensated Work Therapy (CWT) program to help homeless veterans re-enter the workforce.  The program can assist up to 60 veterans at a time by providing an initial period of structured employment.  In addition, a transition housing grant has been funded and a transitional residence has been purchased.  This facility will provide 12 transitional housing beds for up to one year for homeless veterans who are participating in the CWT program.  The homeless program has been awarded a dental grant for the homeless.  The Birmingham Health Care for Homeless Veterans (HCHV) program has been awarded a grant and per diem program, with the Alethia House as the community provider.  This program will have 15 beds and homeless veterans will be allowed to participate in treatment for as long as two years.

The Tuscaloosa HCHV program offers case management services, working with existing mental health services such as the integrated mental illness, addictions and PTSD programs and vocational rehabilitation.   An eight-bed transitional housing program for homeless veterans is provided by the local Salvation Army through a Department of Housing and Urban Development grant.  Substance abuse treatment and CWT are available for homeless veterans in Birmingham. Domiciliary care and residential treatment are provided at Montgomery and Tuskegee, Ala., and Columbus, Ga.  Non-profit organizations were awarded VA grants and per diem payments to establish transitional housing and job training for homeless veterans.

CAVHCS has a 43-bed homeless domiciliary on the Tuskegee campus that offers a therapeutic, home-like environment designed to assist community reintegration of homeless or seriously mentally ill veterans at their highest levels of functioning.  The program provides comprehensive, structured and individualized care.  The treatment focus is on vocational rehabilitation, as well as community re-entry.  The domiciliary program works closely with the CWT program (identifying work situations for veterans) to assure a full continuum of services.  The HCHV program provides outreach services via regular visits to soup kitchens, bridges, community-based homeless shelters and other places where the homeless are known to reside.  HCHV staff has increased the outreach area from four to 15 counties in south-central Alabama and western Georgia, providing a broad range of medical, psychiatric and social services.  Additionally, CAVHCS uses a 12-bed grant and per diem program (House of Restoration) in the Phenix City area.

• Memorial Affairs:  Most men and women who have been in the military are eligible for burial in a national cemetery, as are their dependent children and usually their spouses.  VA manages the country’s network of national cemeteries with more than 2.7 million gravesites at 125 national cemeteries in 39 states and Puerto Rico, as well as in 33 soldier’s lots and monument sites.  In 2006, nearly 97,000 veterans were buried in VA's national cemeteries.  Additionally, VA provided more than 335,000 headstones and markers and 405,000 Presidential Memorial Certificates to the loved ones of deceased veterans.  VA-assisted state veterans cemeteries provided more than 22,000 interments.

VA has two national cemeteries in Alabama.  In 2006, the Fort Mitchell National Cemetery in Seale had 454 interments.  The Mobile National Cemetery, which buries only eligible family members and cremated remains, had 10 burials.  VA is also examining possible sites for a future cemetery in the Birmingham area.  VA provided 6,679 headstones and markers for the graves of veterans in Alabama and sent 2,793 Presidential Memorial Certificates to Alabama survivors of veterans.