WASHINGTON, DC—Last month legislators heard from veterans’ advocates on the major deficiencies in caring for the physical injuries of the nation’s newest veterans. They were told of possibly systemic staffing issues, especially for specialty care and long-term care. They were also told of an overall need for VA to rebrand itself in the eyes of Americans as a place where quality care can be had.

According to VA’s June 2010 Queri Fact Sheet on Polytrauma and Blast Related Injuries, more than 37,000 OEF/OIF servicemembers have been wounded in action and of those more than 20,000 were unable to return to active duty within 72 hours, presumably because of the severity of their injuries. Blasts were listed as the most common cause of injury. From March 2003 through March 2010, a total of 1,792 inpatients with severe injuries were treated at VA’s Polytrauma Rehabilitation Centers.

Staffing Up for the Long Term

“VA is seeing a demand for service that they never could have imagined,” Carl Blake, national legislative director of the Paralyzed Veterans of America, told the House VA Committee last month. This has resulted in the agency’s healthcare facilities being understaffed, particularly in areas heavily impacted by returning soldiers, such as vision specialists, prosthetic and rehabilitation specialists, and long-term care providers.

The American Legion conducted site visits of VA facilities and found staffing to be an issue throughout. “Staffing shortage was a major issue at our site visits. There’s a serious shortage for specialty care,” declared Denise Williams, the American Legion’s assistant director for Health Policy.

VA also needs to heavily invest in long-term treatment programs for seriously injured patients, advocates argued. The patients currently being treated in VA’s polytrauma units and those in other VA facilities being treated for TBI and other injuries will need years of rehabilitative therapy‚Äîa prospect VA might not be ready for.

In a March 2010 report, the IoM suggested that more research and program development is needed to substantiate the usefulness and cost-effectiveness of protocols being used for long-term management of TBI and polytrauma. According to IoM, the array of potential health outcomes associated with TBI suggests that veterans will present long-term medical and psychosocial needs, from persistent physical disability as well as cognitive deficits and psychosocial problems that may develop later in life.

VA has short-term transitional rehabilitation programs. However, the average length of stay at such a unit is three months, and spaces are limited. VA needs to invest in a variety of transitional programs and commit to years of therapy for blast-injured patients, VSO representatives told legislators.

VA needs to redirect some of its focus on the short-term improvement of TBI patients, explained Tom Tarantino, legislative associate for the Iraq and Afghanistan Veterans of America. “Caring for TBI is not just about increasing ability and improvement, but making sure they don’t get worse. They need to be honest about the realities of TBI.”

That reality means long years of regular therapy so patients can keep their current level of functioning‚Äîyears of therapy that VA needs to start staffing and preparing for now. “A lot of those [patients’ goals] are going to be just wanting that level of functioning,” Tarantino said. “These patients need time and money and care, and the structure just isn’t there to provide it.”

Rebranding VA

Twenty years ago, the perception of VA healthcare facilities was of monolithic buildings that were home to subpar care programs—a destination of last resort for ailing veterans. Today, after massive infusions of cash and a comprehensive modernization and decentralization initiative, the reality is a healthcare system that consistently ranks near the top in the nation. However, the perception remains.

Older veterans still envision poor care and immovable beaurocracy. Younger veterans might be unfamiliar with the system entirely, except for the occasional news story‚Äînot always a positive one. “Some of our members openly fear going to VA,” Tarantino revealed to committee members. “Recent media reports of hepatitis and HIV exposure only fuel that problem. VA and VA healthcare have a massive public relations problem.”

VA, he said, needs to embark on a massive effort to rebrand itself, otherwise all of its outreach efforts will be for naught. “For those able to get into VA, care is very good. [But most veterans] don’t know that.”

Most of the information new veterans get about VA comes from the media or from fellow soldiers. And they do not distinguish between problems receiving benefits and problems in healthcare. “We know the VA is three separate agencies working mostly independently of each other. As a veteran, I don’t understand that. When benefits are a problem, I’m mad at VA, not at VBA. When I can’t get an appointment, I’m mad at VA, not VHA,” Tarantino said.

Many times the first experience a veteran has is trying to apply for benefits, or hearing about a fellow servicemember’s experience doing the same. A bad experience might keep them from seeking care at VHA. VA must actively seek out and make relationships with servicemembers when they’re still in the military, Tarantino declared. “VA must shed its passive persona.”

Conversely, VA must stop focusing its outreach and public relations efforts on reaching out to veterans. “The department needs to start reaching out to Americans,” he explained. “VA is not going to catch the attention of the veteran. They’re going to catch their mother, their brother, their girlfriend.”

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