Home Based Primary Care     References Contact Information Care Coordination/Home Telehealth Program Patient Guide Home Based Primary Care (HBPC) is a group effort between the veteran, family, caregiver, Department of Veterans Affairs (VA), and community. The program uses a team of health care professionals who work together to create a plan of care for each veteran. The program is designed to meet the needs of veterans who are homebound because of illness, caregiver issues, or whose care needs will best be met within their own home. Goals Provide primary care in the home Improve quality of life Restore health so the veteran can function at the highest level Help veterans achieve their greatest degree of independence Reduce the need for admissions and re-admissions to the hospital Reduce the length of hospital stays Reduce the number of outpatient visits Support caregivers in their desire to keep a loved one at home Services Teaching, management and administration of medication Wound, pain and medical management Laboratory draws Tele-home care Care coordination between VA and community care providers Eligibility Veterans confined to their home with chronic health problems that require ongoing care Veterans being discharged from the hospital and require short-term follow-up care at home to become fully independent Veterans near the end-of-life who wish to die at home Veterans unable to manage their own health care If you would like a referral to the HBPC program or need more information, ask your primary care provider. Meet the Team The HBPC team meets with the veteran and his/ her loved ones. Together we create a plan of care that is unique to each veteran. The HBPC team includes staff from: Medical – to provide care management and consultation Nursing – to provide case management, patient safety information, individual instruction and guidance for the patient and/or caregiver(s) Social Work – to provide counseling about financial and personal problems Nutrition – to help with teaching and supervision of special diets and/or problems Psychology – to provide select patients with psychological counseling and testing Pharmacy – to reviews the patient’s medical records and review drug therapy Mission The program brings needed medical care to veterans in their homes. We provide medical care, education about managing diseases, support for veterans and caregivers, and help in coordinating all aspects of the veterans’ medical care plan.

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