Care of older veterans

Since the end of World War 1, a system to provide care to Australian Defence Force (ADF) personnel whose health was affected by military service has been in place. Today, the responsibility for the provision of this care lies with the Commonwealth Department of Veterans’ Affairs (DVA). Because of the large number of ageing World War 2 veterans over the past two decades, the DVA has developed considerable expertise in supporting community, residential aged care facility (RACF) and hospital health service provisions to veterans.

Historically, ‘veterans’ referred to those who served in a war zone; however, the DVA uses the term to encompass those:¹

• who served in a war zone
• whose health was affected by service in the ADF who may never have left Australia
• who are widows, widowers or partners of the first two categories.

To qualify for care under DVA arrangements, the veteran must hold a DVA card. There are two types of cards:²

• White Card – covers healthcare for a specified condition or conditions
• Gold Card – covers all healthcare without restriction

General practitioners (GPs) who believe their patient is an ex-service person with a condition that may be covered under DVA arrangements can refer that patient to the welfare officers of ex-service organisations (eg Returned Services League [RSL]). This is also the case for their spouse/partner when their death may have been caused by such a condition.

The use of these welfare officers considerably shortens the time it takes to acquire the necessary approval from the DVA. Patients who served in a war zone and developed a malignancy or tuberculosis are covered under what is called a ‘no liability White Card’; obtaining one of these is a relatively brief process. Similarly, if the patient has served on a full-time basis in the ADF, a no liability White Card can be obtained to cover any mental health condition treatments.

GPs who are uncertain if their patient who is a veteran is covered under any DVA arrangements, or what conditions are covered under the White Card, can ring DVA’s Health Provider Line on 1800 550 457.

Those covered under DVA arrangements are entitled to have all medical services available under the Medical Benefits Schedule (MBS) provided to them with no out-of-pocket costs. Medical practitioners who see patients covered by DVA receive a higher rebate for the services they provide.³ The DVA will provide hospital care in either the public or private hospital system; in the private system, patients are only entitled to shared-ward accommodation. Veterans are also covered by the DVA for RACF fees to the same level as other older Australians.⁴

The DVA provides dental, psychological and allied health services at no charge to the veteran.⁵ Allied health services require a referral from the patient’s treating GP or another specialist medical practitioner.⁶

The Repatriation Pharmaceutical Benefits Scheme (RPBS) contains a small number of drugs that are not available under the Pharmaceutical Benefits Scheme (PBS).⁷

Pharmacist advice on what medications may be covered by the DVA is available 24 hours a day from the Veterans’ Affairs Pharmaceutical Advisory Centre on 1800 552 580. This is also the number to ring should medical practitioners require an authority prescription or increased quantities of medications for veterans.

The RPBS also incorporates a range of dressings for chronic wound and ulcers for eligible veterans.

The DVA also runs a quality assurance program for pharmaceuticals for veterans known as Veterans’ MATES. This program provides feedback to the patient’s GP and the veteran on how best to use medication in the treatment of common conditions.

There is an extensive body of reference material available on the Veterans’ MATES website in a short, easy to read form. The topics covered include many common conditions in older people, and provide a useful reference source for general practice registrars and experienced GPs.

GPs who prescribe for veteran patients with conditions that are topics of interest for the quarterly Veterans’ MATES campaigns will receive a mail-out indicating that their patient has been identified. It will also include some suggestions on what may need to be considered, and a short leaflet is included outlining the scientific basis on how best to manage the condition. The veteran also receives information suggesting the value of talking to their GP in order to optimise their medical treatment. GPs may be eligible for The Royal Australian College of General Practitioners’ (RACGP’s) Continuing Professional Development (CPD) points if they complete the feedback sheet sent to them with the veteran letter.

The DVA provides psychological services to veterans and their families. This program was previously known as the Veterans and Veterans Families Counselling Service, but is now known as Open Arms. There is an extensive network of both DVA-provided and psychology/counsellor contractors available to veterans. GPs can find more about this service on the Open Arms website.

VVeterans with disabilities who require aids to maintain independence may obtain these under the Rehabilitation Appliances Program (RAP).⁸ The RAP will also provide for those considered to require access ramps and rails within the patient’s dwelling place. Information on the RAP is available on the DVA website.

Veterans living in RACFs may not be entitled to aids and appliances, as the DVA’s contracts with RACFs require the facility to provide these services. Similarly, allied health services for those living in RACFs may not be covered under DVA arrangements. If you are uncertain whether the veteran patient living in an RACF is entitled to support under the RAP or DVA allied health arrangements, contact the DVA Health Provider Line on 1800 550 457.

For older veterans who are not able to travel either using their own transport or public transport to attend medical or health-related appointments, the DVA can provide transport services. The DVA uses contractors to provide this service, and information on how to book is available on the DVA website. The DVA will also meet the cost of ambulance transport in an emergency for conditions covered under its arrangements.

For veterans who reside in rural and remote communities who are required to travel to larger centres for medical care, there are arrangements that can significantly subsidise the cost of such travel. If required, the costs of an accompanying person may also be covered, and further details are available on the DVA website.

For the veteran to be able to claim these expenses, it is necessary for the GP to complete part of a claim form indicating that these services were medically necessary.

The DVA also provides support to ex-service organisations, particularly the RSL, Legacy and War Widows Guild. These organisations provide a useful source of social support for eligible veterans, and GPs who feel the older veteran may need some social support should contact these organisations.

For patients who require nursing support at home for dressings, supervision of medication or hygiene, the DVA can provide a home nursing service through contractors. Information about this service is available on the DVA website.

To maintain patients at home when they are unable to perform household maintenance tasks, the veteran is eligible to receive support under the Veterans’ Home Care arrangements. Information about this service is available on the DVA website.

If a patient who holds a DVA Gold Card has a chronic condition and complex healthcare needs and is at high risk of un-planned hospitalisation, the DVA may contact the GP about placing the patient on the Coordinated Veterans Care Program. This program pays your practice a sum of money to provide coordinated care particularly using your practice nurses. Details of this program are available on the DVA website.

The DVA is a GP-friendly organisation. Any queries about any aspect of care for a veteran patient should be directed to the DVA Health Provider Line on 1800 550 457.