GAO - VA Vocational Rehabilitation and Employment Program: Independent Living Services and Supports Require Stronger Oversight. Why GAO Did This Study. Of the 9,2. 15 veterans who entered the Department of Veterans Affairs' (VA) Independent Living (IL) track within the Vocational Rehabilitation and Employment (VR& E) program from fiscal years 2. Vietnam era veterans in their 5. The most prevalent disabilities among these veterans were post- traumatic stress disorder and tinnitus (. GAO's review of 1. IL cases from fiscal year 2. VR& E provided a range of IL benefits to veterans; the most common benefits being counseling services and computers. Less common benefits included gym memberships, camping equipment, and a boat. GAO estimates that VR& E spent nearly $1. IL track in fiscal year 2. IL veteran. About 8. IL veterans were considered by VR& E to be . These plans identify each veteran's independent living goals and the benefits VR& E will provide. The remaining 1. 1 percent of cases were either closed for various reasons, such as the veteran declined benefits, or were still active. Rehabilitation rates across regions varied from 4. IL caseloads generally rehabilitated a greater percentage of IL veterans. On average, IL plans nationwide were completed in 3. GAO identified four key areas where VR& E's oversight was limited. First, some regions may not be complying with certain case management requirements. For instance, while VR& E is required to coordinate with the Veterans Health Administration (VHA) on IL benefits, VR& E counselors have difficulty obtaining timely responses from VHA. This has resulted in delayed benefits or VR& E providing the benefits instead of VHA.
About Services for Older Youth & Independent Living. Independent Living services should not be limited to foster care youths that receive the independent living stipend. Independent Living Program; VOW to Hire. VA provides memorial services and allowances to help reimburse burial costs for a Veteran and. The Independent Living Services (ILS) Program assists people who have significant disabilities to live more independently in their homes and communities. The four core services that every Independent Living Center provides. Second, VR& E does not systematically monitor regional variation in IL caseloads and benefits provided. Instead, it has relied on its quality assurance reviews and ad hoc studies, but these are limited in scope. Third, VR& E's policies for approving IL expenditures may not be appropriate as regions were permitted to purchase a range of items without Central Office approval, some of which were costly or questionable. In one case GAO reviewed, Central Office review was not required for expenditures of $1. The Independent Living Program is a United States Department of Veterans. VA ILP may include the following services. The Assessment of Needs is used by the VRC to create an Individualized Independent Living Plan. Finally, VR& E's case management system does not collect information on IL costs and the types of benefits purchased. VR& E also lacks accurate data on the number of IL veterans served. While the law currently allows up to 2,7. IL track annually, data used to monitor the cap are based on the number of IL plans developed, not on the number of individual veterans admitted. Since veterans can have more than one IL plan in a fiscal year, one veteran could be counted multiple times towards the cap. VA plans to make modifications to its case management system to address this, but officials noted that it could take up to 3 years to obtain funding for this project. What GAO Found. The IL track- -one of five tracks within VA's VR& E program- -provides a range of non- employment related benefits to help veterans with service- connected disabilities live more independently when employment is not considered feasible at the time they enter the VR& E program. These benefits can include counseling, assistive devices, and other services or equipment. This testimony is based on GAO's report issued in June 2. IL track, and the types and costs of benefits provided; (2) the extent to which their IL plans were completed, and the time it took to complete them; and (3) the extent to which the IL track has been administered appropriately and consistently across regional offices. GAO analyzed VA administrative data from fiscal years 2. IL track in fiscal year 2. In addition, GAO visited five VA regional offices; interviewed agency officials and staff; and reviewed relevant federal laws, regulations, and agency policies, procedures, studies, and other documentation. What GAO Recommends. In its June 2. 01. GAO recommended that VR& E explore options to enhance coordination with VHA, strengthen its oversight of the IL track, and reassess its policy for approving benefits. VA agreed with these recommendations. For more information, contact Dan Bertoni at (2. Independent Living Program in VA Education ILP, Ch. Ch 3. 5, GI Bill Forum. PROGRAM DESCRIPTION. The Achievement of a Vocational Goal Is Not Currently Reasonably Feasible. To establish that it is not currently reasonably feasible for a veteran to. CP (counseling psychologist) must find that the veteran's disabilities currently affect his or her employability to either of. The veteran cannot participate in a program of vocationally oriented training and services; or. The veteran is able to successfully pursue vocational training, but it would be highly improbable for the veteran to obtain and retain employment. Reasons for Authorizing a Program of IL Services. The VR& C (Vocational Rehabilitation and Counseling) Division may authorize a program of IL services. This program of rehabilitation services may be furnished. Function more independently in his or her family and community without the assistance of others or with a reduced level of assistance from others. Become reasonably feasible for an extended evaluation; or. Become reasonably feasible for a vocational rehabilitation program. Independent Living and Independence in Daily Living. Independence in daily living means the ability of a veteran, either without the services of others or. Operationally, independent living is synonymous. Program of IL Services and Assistance. A program of IL services and assistance may include the following benefits. The services provided in 3. CFR 2. 1. 3. 5(d), including the counseling, diagnostic, medical, social, psychological, and educational services which the CP. The subsistence allowance and other monetary assistance authorized by 3. CFR 2. 1. 2. 60, 2. The special rehabilitation services under 3. CFR 2. 1. 1. 50, 2. Barriers to Independent Living. The goal of an IL program is to increase the veteran's options, resulting in an improved quality of life. For example, some veterans may be able to overcome certain cognitive. Some independent living program participants may need to learn how to manage personal care. For others, technological devices such as motorized wheelchairs or vehicle modifications may. Supportive services, e. Architectural modifications and advocacy to promote disabled persons, rights to barrier- free access may reduce. Peer and professional counseling may decrease psychological hindrances to independence. A disabled veteran's anxiety about. Independent Living Services and the Rehabilitation Process. The goal of the IL program is not necessarily that the disabled veteran be able to live alone in. Rather, the goal is for that individual to have the skills necessary to choose an acceptable life- style and then be. ELIGIBILITY FOR PARTICIPATION. To be eligible for a program of IL services, VA must determine that. The veteran meets the basic eligibility and entitlement criteria for participation in a rehabilitation program. July 2. 2, 1. 99. M2. 8- 1, Part II. Achievement of a vocational goal is not currently reasonably feasible. The veteran has IL needs; and. The achievement of an IL goal is currently feasible; that is, VR& C staff members expect the IL services proposed will enable the veteran to live. As part of an IL program. VA may provide are those incidental to achieving intermediate IL objectives. Some of the IL services which VA may authorize. Training in activities of daily living. Training in IL skills. Attendant care during a period of transition (see par. Transportation when special arrangements are required due to the disabling condition. Evaluation or training in an IL program. Housing (group, transitional, or housing specifically designed to meet the needs of disabled persons). The duration of a program will not exceed 2. Extension for 6 Months. The CP may approve an extension of a program of IL services for up to 6 months if the additional period is necessary and should. The CP must carefully document in the veteran's CER (Counseling/Evaluation/Rehabilitation) folder specifically how. No program may exceed 3. Limitation of Selected Services. Some IL needs identified during the initial phase of program planning for a veteran may require services following. For example, the veteran might have a life- long need for a personal care. Since the time a veteran can participate in the program is limited, program planning must focus on ways to meet. IL program participation. Vocational rehabilitation program funding for long- term needs is limited to the IL program period. In no. instance, however, may the VR& C Division provide these services beyond the maximum 3. IL program. Basis for Subsistence. Measure participation on a clock- hour basis. Pay subsistence allowance based on the number of clock hours spent in training directly. IL skills- such as money management, personal care attendant management, and household maintenance. To measure the rate of. CFR 2. 1. 3. 10(d). In view of the severity of the conditions of IL program participants, the CP must determine whether the veteran is entitled under. CFR 2. 1. 3. 12) to a higher rate of subsistence allowance than VA would otherwise pay for a given level of participation. Participation in traditional medical therapies (e. VA Form 2. 8- 8. 87. Rehabilitation Plan. PROCUREMENT OF SERVICES. Authorization of Services and Supplies. The case manager will authorize the services, incidental goods, and supplies necessary for the veteran to accomplish. IL program. For these authorizations, the case manager will follow the policies and procedures in part III, chapters 2 and 6. If the case. manager anticipates that program charges will require the approval of the Director, Vocational Rehabilitation Service, the regional office should follow the. II, chapter 3 to make a specific request to obtain approval of costs. Approved Service Providers. Normally VR& C Divisions will use VA facilities to provide IL services to veterans participating in the program. If the. VR& C Division cannot make timely, effective, and cost- efficient arrangements for VA facilities to provide these services, then the VR& C Division may. VA medical facilities are likely to be the best resources for VR& C Divisions to obtain authorized services as either part or all. IILP. If these services are not available through VA medical facilities or the VR& C Division cannot make appropriate arrangements to timely use these. CP will document this in the veteran's record. ROLE OF THE COUNSELING PSYCHOLOGIST. Identification of Veterans. The CP must review each case in which a vocational goal is not currently reasonably feasible to determine if a program of IL. If a VRS will act as case manager, the VRS will also take part in the plan development (see subpar. Provision of IL Services When a Vocational Goal Is Feasible. When establishing a veteran's entitlement to services under chapter 3. CP must. document in the CER folder why the achievement of a vocational goal is not currently reasonably feasible. If vocational rehabilitation is currently reasonably. IL skills, the CP should. IL services into an IWRP (individualized written rehabilitation plan). The case manager will arrange for these services as a preliminary. Determination of Feasibility for Program of IL Services. In evaluating clients for inclusion in the program of IL services, the CP must determine that it is. VRP). Denial of IL Services. If the CP determines that the achievement of a vocational goal is not currently reasonably feasible and the CP does not approve a. IL services, the CP must obtain the VR& C Officer's concurrence in the decision (2. CFR 2. 1. 5. 3(f)). If the VR& C Officer does not concur. CP must work with the VRS case manager and the veteran to develop a plan of IL services. Veteran's Involvement. IILP Development. The CP will solicit the veteran's cooperation in negotiating and agreeing to the terms of the IILP. When the CP and the veteran have. CP and the veteran will sign the plan to indicate mutual understanding and. Unless a VRS will assume case management responsibilities, there will be only two signatures on the IILP. The veteran will receive a. If the CP and veteran cannot agree on the terms of the plan, the CP will request that the VR& C Officer review the. The VR& C Officer will resolve the disagreement and ensure that plan development continues. The veteran or his or her representative may request administrative review of a proposed original or amended rehabilitation. Within 1 year of written notification of the CP's decision regarding the veteran's plan, the veteran or his or her. BVA (Board of Veterans Appeals) by filing a notice of disagreement (see pt. VR& C. staff members will inform the veteran that any administrative review must take place prior to appealing the decision to BVA. Once the veteran files a notice of. VR& C Officer must immediately stop any administrative review in progress and begin appellate processing. Medical and Physical Therapy Assessment. Standard medical history and physical examination by appropriate medical or physical restoration specialists should. Overall physical health. Ability to regulate and manage own health. Musculoskeletal and body movement. Range of motion. (6) Muscle strength. Functional balance. Functional mobility; and. Gait. Neurological Assessment. Following brain trauma, the neurological assessment should identify an individual's cognitive, emotional, social, and. A comprehensive assessment should address the person's. Attention and concentration. Learning and memory. Recent memory. (4) Remote memory. Visual- spatial abilities. Fine- motor abilities. Higher- order and executive cognitive abilities. Emotional adjustment; and. Chemical abuse and dependency.
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