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June 23, 2014

Home: Where it all begins and matters most

Home: Where it all begins and matters most

By COL (Ret.) James D. McDonough, Jr., Daniel Savage and Jim Lorraine

FlagWhen soldiers and airmen like us (and more than two million others like us) returned from our deployments, we were welcomed home in crowded gymnasiums by our families and friends who eagerly awaited our return from war; we didn’t go to the White House to shake hands with the President or the Secretary of Defense. When we began looking for jobs, we spoke with front-line hiring managers in our cities and towns from companies like Walmart, JPMorgan Chase and GE; we didn’t go to Bentonville, Arkansas or New York City to interview with Bill Simon, Jamie Dimon or Jeff Immelt. Likewise, when we first needed health care following our service, we went to our nearest VA hospital to seek the care and assistance of local providers; we didn’t sit in then-Secretary Shinseki’s office at VA headquarters in Washington, DC to fill out our paperwork.

Separation from service and transition happens at home, wherever we call home. As has been made abundantly clear by the recent release of an internal Department of Veterans Affairs audit, tens of thousands of newly returning veterans wait at least 90 days for medical care, while even more who signed up in the VA system over the past 10 years never got the initial appointments they requested. Tragically, the VA has acknowledged 23 deaths nationwide due to delayed care. This particular issue of VA health care failures at the local level highlights an important truth: national policies, national hiring initiatives, and national leadership may indeed be the subject of great debate and discussion in Washington, DC, but what happens locally in America’s communities is what makes or breaks a veteran’s transition, and may even change, save – or end – their life.

There’s something else abundantly clear to vets like us – the system of care, services, and benefits earned through military service and reactively discussed in our nation’s capital (as failures continue to be discovered) has failed some to the extent that the only way to fix things may be to completely break the model of veterans’ services as we know it today. That system, to those of us who may come to rely upon it as our wounds, illnesses or injuries worsen with time, needs to be centered more and more in the communities where we live and work. The time has come to see our communities more heavily invested in caring for veterans – in all ways – whether that be providing access to care within the VA or through private providers, whichever we prefer, given our unique health circumstances and needs.

We need health care and services that work for us.

Veterans’ health care must be flexible enough to process the waves of returning post-9/11 veterans alongside the generations of aging veterans from previous conflicts, who are beginning to use services to an increasing degree. That means that if care should be delivered in the community, VA provides it – whether that be direct care, fee-based or by voucher as Congress has currently proposed. And very importantly, that care must be coupled with services and resources known through research as the ‘social determinants’ of health and wellbeing. Delivered best by our web of nonprofit organizations in our communities, these services must be integrated with VA benefits and services through sanctioned public/private partnerships, and supported by local foundations which complement the VA’s mission, seeding and cultivating best practices.

Similarly, alongside VA mental health professionals, the community must be prepared to treat moral injury, as some veterans wrestle with the complexity of the things they have seen and the difficult choices they have had to make in combat.  Alongside VA employment programs, community colleges and universities must be prepared to train veterans for their next career and ready them to transition into a still uncertain employment landscape, first by graduating them at acceptable rates. Our nation’s employers, who have stepped up with impressive hiring commitments, must ensure that these trickle down, are integrated with educational institutions, and find their local veterans to make good on their promises.

In short, we need a more integrated system of care, services and resources supported by our nation and implemented through the collective action of our communities. Too often these various actors – the VA, nonprofits, educators, employers and philanthropy – have failed to collaborate as a cohesive network, but rather this system is poisoned by territorialism and competition for scarce resources. Donors are blinded by the desire to demonstrate the singular impact of their dollar and fail to see the value of investment in infrastructure which supports collective impact effort that create greater gains for the community. Within America’s communities, networks of organizations must come together with a unified mission of serving their veterans, coordinating their disparate but mutually-reinforcing activities through regular communication, with common metrics for success.  Such networks need to be valued by our government and held accountable for performance by their communities.

Without a collective vision seeking collective impact, our nation’s veterans and their families can become lost and confused in the maze of organizations and resources. Without a collective vision seeking collective impact, some in our generation may begin to slip through the cracks like generations before them, on track for the pitfalls of long-term unemployment, substance abuse, and homelessness. Without a collective vision seeking collective impact, an unintegrated, monolithic VA may collapse under the weight of its own case load, and more veterans like us may be poised to see their health and wellbeing compromised by the very nation that sent us to war and back.

This crisis at the VA should serve as the clarion call to both the government and America’s communities to begin acting as one. The war in Afghanistan may be ending, but the work of transitioning our veterans is just beginning – the system is overwhelmed, and it’s only going to get worse before it gets better.  Making that system of care, services and resources better is the responsibility of us all, beginning in Washington and ending at home, where it all begins and matters most.

About the authors: Colonel (Retired) Jim McDonough is Managing Director of Community Engagement and Innovation at IVMF. Dan Savage is Senior Director of Community Engagement and Innovation at IVMF. Their bios can be found here at Jim Lorraine is President of Augusta Warrior Project in Augusta, Georgia.


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