Introduction
The U.S. Department of Veteran Affairs (also called Veterans Administration, VA) collaborates with the federal government support the lifelong medical needs of eligible and identifiable military veterans. To achieve this objective, VA has established around 170 centers intended to offer personalized outpatient and inpatient services in the country. It collaborates with most of the available resources and agencies across the country to meet the demands of American veterans. Unfortunately, VA continues to grapple with numerous challenges that affect the timeliness and quality of medical services available to these citizens (Morgan et al., 2020). On top of the list is the absence of proper transportation strategies designed to support the expectations of the served individuals. In most cases, veterans living in different regions would be unable to move from point A to B in search of high-quality medical services.
Another outstanding challenge revolves around the longstanding issue of veteran homelessness. While some of these beneficiaries have access to housing vouchers, it becomes increasingly difficult for them to find reliable landlords in their respective regions. This predicament results in additional problems for most of these individuals. Such issues have triggered an additional concern that the leaders at VA need to examine from an informed perspective (Wolfe & McDonald, 2020). Specifically, more veterans have been reporting high rates of suicide. Without proper support mechanisms, the agency would be unable to deliver on its official mandate to the American people.
Annotated Bibliography Reflection
Morgan, N. R., Aronson, K. R., Perkins, D. F., Bleser, J. A., Davenport, K., Vogt, D., Copeland, L. A., Finley, E. P., & Gilman, C. L. (2020). Reducing barriers to post-9/11 veterans’ use of programs and services as they transition to civilian life. BMC Health Services Research, 20(1), 525-538. Web.
Nine researchers collaborated to write the selected article in an effort to report the progress made in the area of veteran programs implementations. The surnames of these writers include Morgan, Aronson, Perkins, Bleser, Davenport, Vogt, Copeland, Finley, and Gilman. In the article, Morgan et al. (2020) wanted to examine the practicability of the programs put in place to empower veterans since 2002. Most of these measures were intended to mitigating the existing barriers whenever veterans were accessing a wide range of services, including medical support. With over 20 percent of the respondents willing to use initiatives that addressed transportation barriers, it was evident that such a gap affected service delivery. The findings revealed that most of the mechanisms put in place were incapable of addressing most of veterans’ needs.
After reading the article, several ideas emerged regarding the issues most of the veterans in the U.S. were going through. For instance, the move to offer programs intended to empower these beneficiaries failed to deliver most of the intended results. Some of the individuals were keen to identify measures that were capable of tackling transportation challenges (Morgan et al., 2020). The researchers went further to support the introduction of additional measures to improve transportation. The lesson gained from the article is that the reduction of veteran barriers affecting access to medical services could make it easier for them access VA-sponsored medical facilities. The development can help address additional challenges these people experience, such as terminal illnesses, depression, and homelessness.
Ijadi-Maghsoodi, R., Feller, S., Ryan, G. W., Altman, L., Washington, D. L., Katooka, S., & Gelberg, L. (2021). A sector wheel approach to understanding the needs and barriers to services among homeless-experienced veteran families. Journal of American Board Family Medicine, 34(2), 309-319. Web.
The authors of this article included Ijadi-Maghsoodi, Feller, Ryan, Altman, Washington, Katooka, and Gelberg. The primary aim behind completing the study was to examine some of the challenges veterans encountered in the United States. Most of these individuals remained homeless due a wide range of barriers, thereby being unable to receive most of the outlined VA support. Such an initiative would shed more light and present additional guidelines for empowering more healthcare providers to remain supportive and informed (Ijadi-Maghsoodi et al., 2021). The absence of proper mechanisms, family-focused care, and community support led to increased problems, such as poor health outcomes and lack of housing.
The reader is able to identify several lessons from this specific research. Specifically, it is notable that the current level of discrimination compels landlords not to accept some of the housing vouchers from veterans. This malpractice was a leading contributor to the increasing rates of homelessness among different underserved populations (Ijadi-Maghsoodi et al., 2021). Without a home, these individuals were unable to get the much-needed transportation to access most of the healthcare facilities. The lesson gained from this article is that the involvement of all key stakeholders is necessary if VA is to identify and address most of the challenges American veterans face. The reader learns that most of the involved agencies, programs, and care providers could collaborate to introduce additional initiatives to meet the demands of these individuals.
The question of veteran welfare led to the establishment of VA as the primary agency tasked with providing timely support and empowerment to soldiers who had served the country diligently. This federal department liaises with most of the established institutions and organizations to identify vulnerable veterans and re-pattern their experiences. Unfortunately, VA continues to grapple with numerous challenges that have negative implications on the outcomes of most of these individuals (Morgan et al., 2020). The selected topic for this analysis is, therefore, that of VA and the predicaments affecting its operations.
The U.S. government decided to form VA in 1930 to undertake a wide range of services intended to support veterans. By the year 1982, the agency acquired additional roles, such as providing care to civilians during emergencies. The leader of this organization is the Secretary of Veterans Affairs.. The organization’s annual budget is usually around 110 billion US dollars (Morgan et al., 2020). Currently, VA has around 360,000 employees working in different regions across the country to focus on the welfare of veterans. This agency collaborates with the Veterans Health Administration (VHA) to support the delivery of timely medical services to veterans.
The problems of lack of transportation and homeless continue to affect the performance of the U.S. VA. While this agency has the primary responsibility of supporting eligible veterans, other organizations could be blamed for failing to implement proper policies and initiatives to empower such beneficiaries. These predicaments have developed over the years due to the gaps associated with several agencies. First, VHA has not introduced adequate mechanisms to meet the needs of veterans with disabilities and inability to travel and receive timely medical services. Second, the National Coalition for Homeless Veterans (NCHV) has some gaps that disorient the level of accountability. By failing to focus on at-risk individuals, over 40,000 veterans still remain homeless in the U.S. (Wolfe & McDonald, 2020). Third, Veterans Service Organizations (VSOs) are yet to provide personalized and timely services to most of the veterans incapable of accessing health facilities.
Review of Literature
- Veterans: Ex-members of the U.S. military
- Electronic Health System (EHS): digital version of citizen’s health records and charts accessible real-time
- Telehealth: System supporting the adoption of digital communication and information systems to offer medical support remotely
- Data integration: Combination of data from various sources to develop a unified view
- COVID-19: Coronavirus disease of 2019, a global pandemic that began in 2019 in China
- PTSD: Post-traumatic stress disorder, mental illness characterized by terrifying events arising from flashbacks of past experiences
Veterans in America continue to receive numerous benefits for having served the country and presented its interests at the global level. This tradition has existed in the nation since the 1770s during the infamous Revolutionary War (Oluyede et al., 2022). Some of the support strategies already in place include provision of medical services, pensions, care for disabled, and additional self-empowerment programs. However, the question of transportation presents a unique conflict in VA since a good percentage of veterans are presently unable to commute to their favorite or nearest healthcare institutions. The relevant organizations have been focusing primary on the experiences and outcomes of veterans who show up. In a study by Mark et al. (2020), it emerged that most of the agencies expected to partner with VA failed to engage in follow-up initiatives to target veterans encountering challenges with transportation. Consequently, such individuals were unable to record positive health outcomes.
Different societies have considered evidence-based approaches to empower veterans in such a way that they have access to transport options. For example, MacLean et al. (2019) observed that the government of Canada was implementing timely mechanisms to identify disabled veterans who were facing different challenges when looking for medical services. In another study, it occurred that the relevant agencies collaborated to identify vulnerable individuals and ensure that they were able to access veteran care (MacLean et al., 2019). Additional support systems aimed at addressing veterans’ challenges included employment opportunities and empowerment programs (MacLean et al., 2019). Similarly, Mark et al. (2020) revealed that the United Kingdom (UK) government was keen to monitor the life outcomes of most of the veterans. The relevant agencies were then directed to provide additional support to ensure that most of the beneficiaries recorded desirable outcomes.
To address the nature of this conflict, additional alternatives capable of empowering veterans are evident from different sources. For example, Mark et al. (2020) revealed that the UK government had integrated veterans’ demographics within the wider Electronic Health System (EHS). This move made it possible for medical professionals to be more involved and willing to treat a wide range of diseases and mental problems (Mark et al., 2020). The effort addressed most of the challenges associated with reduced transport opportunities for such members of the population. In their study, Oluyede et al. (2022) examined the issues surrounding COVID-19 and how the pandemic affected the overall level of access to medical services. In their findings, the researchers suggested that telehealth policies could meet the demands of individuals facing transportation challenges (Oluyede et al., 2022). These divergent alternatives continue to be replicated elsewhere to accommodate veterans encountering the same challenge.
Based on the studies completed in the past, evidence is mixed regarding the effectiveness of the implemented strategies. For instance, Oluyede et al. (2022) revealed that the use of telehealth systems could not support the needs of underserved veterans who were unable to access Internet-related services. This revelation means that the model could be ineffective towards addressing the challenges facing VA. Employment opportunities suggested in the work by MacLean et al. (2019) could not meet the needs of veterans aged above 80 years. The most practical approach should, therefore, entail the provision of transportation services to veterans who might be unable to travel to their respective VA medical centers. However, this model ignores veterans who remain homeless due to the rejection of housing vouchers by landlords (Mark et al., 2020). From a comparative approach, personalized efforts to meet the transportation needs of veterans could work effectively to tackle this problem and empower more beneficiaries.
While some approaches sound more favorable, they all present a number of advantages for the others. For example, telehealth and electronic data integration measures are preferable since they reduce transportation costs, increase access rate, and support the provision of timely medical services (Oluyede et al., 2022). These advantages make the approach acceptable in comparison with improved transportation solutions and employment opportunities. For employment strategies, more individuals will get additional financial resources to pursue their medical needs without the need to rely on established VA programs. The model saves costs and reduces the need for Internet access. The improvement of transportation procedures is advantageous over both employment and telehealth since it minimizes delays, meets the needs of underserved individuals, and offers room for continuous improvement.
The outlined tactics have their unique disadvantages that change agents should not take lightly. For instance, telehealth and electronic records could discriminate against veterans who do not have Internet access (Oluyede et al., 2022). Employment opportunities would only support veterans during their early years after retiring from the army. Those above the age of 80 would be in need of continuous support and attention. The proposed transportation approaches could result in additional expenditures while locking out some of veterans in areas without proper road access. Additionally, some of these elderly citizens tend to encounter mental challenges, such as PTSD, that affect the overall process of coordinating for transport services.
Application to the Department of Veterans Affair
For many years, the U.S. has a developed and sustained a unique tradition that supports the welfare of veterans. The priority areas for the U.S. VA have always included access to healthcare, pension scheme, and wellbeing (Oluyede et al., 2022). The absence of proper incentives to tackle some of the emerging problems, such as PTSD, depression, and reintegration into the society is a gap that has triggered additional challenges. Consequently, transportation issues have remained a unique problem facing VA since the 1930s. It is agreeable that the agency has succeeded to identify a lower percentage of veterans who are facing various life problems. However, its inability to analyze most of these complex issues could explain why the identified conflict exists (Wolfe & McDonald, 2020). Specifically, individuals who cannot move to nearby health centers are included in the VTP.
Several examples from VA are worth presenting to explain how the current literature applies to the identified situation. For instance, Wolfe and McDonald (2020) acknowledge that more of the veterans have either become disabled, suffer chronic conditions, or developed mental problems. These challenges result in homelessness and disorientations. Another example is that the existence of personal challenges will tend to disorient the measures put in place to support medical care delivery (Cogu, 2018). The complexity of such problems has triggered the nature of the current situation at VA.
Primary factors and principles are notable that explain the nature of poor transportation for veterans at VA. Key ones include poor coordination, absence of policy mechanisms, and failure to engage in continuous research. Ineffective collaboration increases the experienced gaps since emerging insights are not implemented. Absence of policies explains the history of this challenge and how it continues to affect more veterans in the country (Cogu, 2018). The principle of continuous research refers to additional investigations intended to present evidence-based ideas and solutions to experienced challenges. A detailed analysis of these issues could reveal why the specific problem continues to exist at VA.
Past researchers have gone further to explain how transportation gaps continue to affect several stakeholders in the country. The primary ones include staff members at VA, medical professionals involved in the provision of veteran care, community members, government agencies, humanitarian agencies, and veterans (Wolfe & McDonald, 2020). In terms of impacts, the leading ones include veterans who are usually on the receiving end (Morgan et al., 2020). Researchers have shed more light on this topic to explain how transportation affects different players. For example, most of the affected veterans find it hard to get timely and personalized medical services, a gap that worsens their overall health outcomes (Hale-Gallardo et al., 2021). The second group is that of community members since they are compelled to remain involved to support the individuals (Ijadi-Maghsoodi et al., 2021). Additionally, medical practitioners are eventually compelled to respond to worsening medical conditions that could have been avoided or treated more efficiently and without delay.
Experts in veteran and healthcare have presented unique observations regarding the nature of this problem. For example, Cogu (2018) revealed that poor transportation within the activities of VA compelled caregivers to incur increased costs when providing treatment to patients at advanced disease stages. This challenge resulted in additional expenses, time, and resources. Wolfe and McDonald (2020) observed that delayed transportation for veterans is usually associated with poor coordination of care, time wastage, and increased expenditures. In another study, Hale-Gallardo et al. (2021) revealed that transportation gaps affected the overall process of attaining the outlined VA objectives while resulting in time loss. The government had to incur additional expenses in an effort to meet the demands of veterans who experienced mental problems or had become homeless due to the complexity of the gaps existing at VA.
Based on the nature of this problem, evidence-based approaches are needed to deal with this challenge and ensure that VA is on the right track. According to Wolfe and McDonald (2020), a coordinated effort capable of improving transportation for veterans could make it possible for VA to achieve better outcomes. More individuals would be able to receive timely medical support, thereby reducing the need for additional support, such as housing and advanced care for depression. The effort could trigger additional collaborations among the involved organizations. Hale-Gallardo et al. (2021) acknowledge that the proposed new arrangements could support the reduction of all other notable challenges at VA. Consequently, a win-win situation will emerge and make it possible for more professionals to complete their tasks promptly and diligently.
Proposed Plan to Address the Identified Problem
It is evident that VA is currently grappling with various challenges capable of disorienting its goals. The problem of transportation has the potential to affect the speed of access to emergency and regular health services. This issue has led to additional concerns for the agency, such as an increasing percentage of veterans without timely access to medical services, PTSD cases, and homelessness (Wolfe & McDonald, 2020). While the agency has put in place specific mechanisms to coordinate veteran transportation, such as the VTP, additional approaches would be recommendable to deliver sustainable results. Based on the strengths, resources, programs, and initiatives associated with VA, a practical plan is necessary to address the problematic issue of transportation. Please consider the presented logic model to support this strategy and take VA closer to its mission and organizational goals.
Based on the model presented below, it is agreeable that the specific solution appropriate for the current challenge entails the use of a multifaceted approach. Such a strategy seeks to combine the current programs already in place with additional measures. The proposed ones need to be customized to meet the demands of the greatest number of veterans in the country (Hale-Gallardo et al., 2021). The inclusion of telehealth approaches, combined with the ability to support the transportation of practitioners to provide health services to inaccessible veterans, could improve overall health coverage. The model describes the best way to expand the initiative and focus on the needs of more homeless veterans. To make the plan successful, continuous evaluation is necessary whereby the relevant leaders will receive timely updates (see Fig. 1). The solution tackles the challenge of transportation directly, thereby making it easier for more veterans to get timely and personalized medical services.
The proposed action plan is realistic and capable of delivering the outlined goals in a timely manner. In terms of who, the initiative brings together all the agencies in veteran care, beneficiaries, community members, and federal organizations. The question of what is considered since the initiative is capable of addressing transportation issues most of the veterans encounter while trying to get personalized treatment (Cogu, 2018). In terms of where, the project will be launched at the VA centers across the country. The best timeframe for pursuing the initiative needs to be six weeks to provide room for data collection and implementations based on the recorded findings. In terms of how, the use of Kurt Lewin’s change theory could support the transformation, help mitigate possible resistance, and create room for continuous improvement. The emerging aspects will make it possible for VA to tackle the identified challenge and eventually transform the lives of more veterans in the country.
Conclusion
VA remains an instrumental agency in the coordination of veteran services, such as healthcare and overall welfare. The federal government provides adequate resources to support its operations, liaise with other departments, and complete additional investigations to improve its operations. The completed analysis has revealed that more veterans are left out in the provision of medical services due to challenges arising from poor transportation mechanisms. While specific efforts are in place under the VTP program, sustainable outcomes are yet to be recorded. A coordinated effort is recommendable that combines telehealth, improved transportation opportunities to access various health facilities, and empowerment of physicians and caregivers to locate and provide services to veterans. The involvement of key government agencies and the continuous provision of key resources will determine for the success of the outlined action plan.
References
Cogu, M. (2018). Developing emergency medical transportation services for turbulent future. Global Journal of Sociology Current Issues, 8(1), 13-21. Web.
Hale-Gallardo, J., Kreider, C. M., Ni, Y., Semeah, L. M., Ahonle, Z. J., Cowper-Ripley, D. C., Mburu, S., Delisle, A. T., & Jia, H. (2021). Serving rural veterans with disabilities: A national survey of centers for independent living. Journal of Community Health, 46(4), 740-751. Web.
Ijadi-Maghsoodi, R., Feller, S., Ryan, G. W., Altman, L., Washington, D. L., Katooka, S., & Gelberg, L. (2021). A sector wheel approach to understanding the needs and barriers to services among homeless-experienced veteran families. Journal of American Board Family Medicine, 34(2), 309-319. Web.
MacLean, M. B., Keough, J., Poirier, Al., McKinnon, K., & Sweet, J. (2019). Labour market outcomes of veterans. Journal of Military, Veteran and Family Health, 5(1), 58-70. Web.
Mark, K. M., Leightley, D., Pernet, D., Murphy, D., Stevelink, S. A. M., & Fear, N. T. (2020). Identifying veterans using electronic health records in the United Kingdom: A feasibility study. Healthcare, 8(1), 1-14. Web.
Morgan, N. R., Aronson, K. R., Perkins, D. F., Bleser, J. A., Davenport, K., Vogt, D., Copeland, L. A., Finley, E. P., & Gilman, C. L. (2020). Reducing barriers to post-9/11 veterans’ use of programs and services as they transition to civilian life. BMC Health Services Research, 20(1), 525-538. Web.
Oluyede, L., Cochran, A. L., Wolfe, M., Prunkl, L., & McDonald, N. (2022). Addressing transportation barriers to health care during the COVID-19 pandemic: Perspectives of care coordinators. Transportation Research Part A: Policy and Practice, 159, 157-168. Web.
Wolfe, M. K., & McDonald, N. C. (2020). Innovative health care mobility services in the US. BMC Public Health, 20(1), 906-914. Web.