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§ Geriatricians have expertise in treating conditions that older individuals experience such as loss of mental sharpness, changes in mood, falls, sensitivity to medications, loss of vision and hearing, and incontinence.
§ The American Geriatrics Society says today there’s roughly one geriatrician for every 2,600 people 75 and older. This ratio is projected to fall to one geriatrician for every 3,800 older Americans by 2030.
§ Just 56 percent of first-year fellowship slots in geriatrics were filled last academic year; Only 56 percent of medical students had clinical rotation in geriatrics in 2008.
§ Primary care physicians do not have training or experience to manage complex, older adults with multiple chronic diseases.
§ In order to improve provider training in geriatrics among rural VA providers, the VHA Office of Rural Health has supported the Geriatric Scholars program. This national VA in-service education program is leading the way to quality improvements in rural community-based outpatient clinics across the U.S. The program offers state-of-the-art education in geriatrics to primary care providers, social workers and pharmacists and culminates with each Scholar initiating a quality improvement project in his or her clinic.

[Source: VHA Newsletter The Rural Connection Dec 2011 ++]

VETS: The U.S. Department of Labor, Veterans' Employment and Training Service (VETS) offers employment and training services to eligible veterans through a non-competitive Jobs for Veterans State Grants Program. Under this grant program, funds are allocated to State Workforce Agencies in direct proportion to the number of veterans seeking employment within their state. The grants support two principal staff positions - DVOP (Disabled Veterans' Outreach Program Specialists) and LVEP (Local Veterans' Employment Representatives). This grant provides funds to exclusively serve veterans, other eligible persons, transitioning service members, their spouses and, indirectly, employers. The grant also gives the State the flexibility to determine the most effective and efficient distribution of their staff resources based upon the distinct roles and responsibilities of the two positions.

DVOP and LVER staff provide services to all veterans that Title 38 indicates are eligible for their services, but their efforts are concentrated, according to their respective roles and responsibilities, on outreach and the provision and facilitation of direct client services to those who have been identified as most in need of intensive employment and training assistance. DVOP and LVER staff, through outreach with employers, develop increased hiring opportunities within the local work force by raising the awareness of employers of the availability and the benefit of hiring veterans. Respective roles and responsibilities include:

  • DVOP specialists provide intensive services to meet the employment needs of disabled veterans and other eligible veterans, with the maximum emphasis directed toward serving those who are economically or educationally disadvantaged, including homeless veterans, and veterans with barriers to employment. DVOP specialists are actively involved in outreach efforts to increase program participation among those with the greatest barriers to employment which may include but should not be limited to: outplacement in Department of Veterans' Affairs (DVA) Vocational Rehabilitation and Employment Program offices; DVA Medical Centers; routine site visits to Veterans' Service Organization meetings; Native American Trust Territories; Military installations; and, other areas of known concentrations of veterans or transitioning service members. The case management approach, taught by the National Veterans' Training Institute, is generally accepted as the method to use when providing vocational guidance or related services to eligible veterans identified as needing intensive services.

  • LVEP representatives conduct outreach to employers and engage in advocacy efforts with hiring executives to increase employment opportunities for veterans, encourage the hiring of disabled veterans, and generally assist veterans to gain and retain employment. LVER staff conduct seminars for employers and job search workshops for veterans seeking employment, and facilitate priority of service in regard to employment, training, and placement services furnished to veterans by all staff of the employment service delivery system.

To meet the specific needs of veterans, particularly veterans with barriers to employment, DVOP and LVER staff are thoroughly familiar with the full range of job development services and training programs available at the State Workforce Agency One-Stop Career Centers and Department of Veterans' Affairs Vocational Rehabilitation and Employment Program locations. Applications for funds under the Jobs for Veterans State Grants Program will be accepted only from the designated administrative entity that operates the employment service delivery system within the state. For more information about Department of Labor employment and training programs for veterans, contact the VETS office nearest you, listed in the phone book in the United States Government under the Labor Department or visit our site:

[Source: VETS Employment Services Fact Sheet 1 Dec 2011 ++]
Vet Jobs Update 46: With close to 40,000 troops expected to return from Iraq by the end of 2011 and the recent passing of the VOW to Hire Veterans Act, a bipartisan-supported national bill to encourage businesses to hire military veterans, Sears Holdings is calling on all companies to do their part on an issue where the retail giant leads by example. Sears Holdings recently committed to increase its veteran hiring by 10 percent over the next year, and it has been living up to its word. To date in 2011, Sears has hired 1,636 military members – up more than 200 percent from 2010 — 927 of whom were hired between ` AUG and 7 NOV alone. “With so many military members returning home, the support need increases accordingly, especially during the holiday season,” said David Works, a Navy veteran and SVP and president, Human Resources at Sears Holdings. “Sears has long made supporting U.S. veterans a priority throughout the organization – from numerous hiring initiatives and military-friendly policies to our Heroes at Home program and holiday Wish Registry. We are committed to providing resources for as many of our returning heroes as possible, in order to empower them and help better their lives.”

Sears Holdings Corporation is the nation’s fourth largest broadline retailer with over 4,000 full-line and specialty retail stores in the United States and Canada. Consistent with its aggressive military hiring goals, Sears Holdings currently employs more than 30,000 U.S veterans, with more than 1,500 still serving in the National Guard and reserves, and thousands of military spouses. The Sears Associate Military Support Group helps maintain a positive work environment for these employees. “Hiring veterans is not goodwill, it’s good business,” Works said. “Veterans provide our workforce with a high-level skill set built through brave service to America. They bring the advantages of being immersed in a training environment, and their technical skills, strengths in strategic thinking, and versatility are just a few of the very tangible talents that make them valuable to any employer.”

Another Sears Holdings policy – so military-friendly that it generates year-round inquiries about its validity – is the company’s offer of a military pay differential to its full-time associates who are reservists, serving on active duty. Reservists who are employed full-time are allowed to continue participating in life insurance, medical and dental programs. “We’re humbled by how many calls and emails we receive about the military pay differential policy,” Works said. “These people are amazing employees and it’s the right thing to do to retain them in our ranks.” Via its long-standing Heroes at Home program, Sears has supported U.S. soldiers, by rebuilding homes for veterans and providing gift cards to active service members during the holidays. Since its inception in 2007, the Sears Heroes at Home program has raised more than $30 million to help renovate 1,000 homes and improve the lives of more than 62,000 families. Visit for more information and for ways to contribute to its vital efforts to support the country’s soldiers. For those seeking employment check out [Source: article 2 Dec 2011 ++]

Military Programsmilitary programs


Vet Jobs Update 47: The Department of Labor has announced a new partnership with Microsoft Corp. To provide veterans with vouchers for no-cost training and certifications that can lead to important industry-recognized credentials. The voucher program will serve veterans in five communities with the highest number of returning post-9/11 era veterans: Seattle, Wash.; San Diego, Calif., Houston, Texas; Northern Virginia; and Jacksonville, Fla. Additional information about this and other initiatives, including specific locations where the vouchers will be distributed, is available at the Department of Labor VETS website at An audio file of a press call announcing this initiative is available to download at: For more information about Department of Labor employment and training programs for veterans, contact the VETS office nearest you, listed in the phone book in the United States Government under the Labor Department or visit our site:
A similar opportunity is available through the Syracuse University's School of Information Studies. They are hosting a non-credit online curriculum free of cost to veterans who have served on active duty post 9/11/01, which focuses on preparation for transition to corporate careers in IT or operations. This program is available to both employed and unemployed, post 9/11 veterans with a minimum of a high school diploma, and is comprised of two certificates, VET 1: Career Skills for Global Enterprises and VET 2: Applied Technology Education. By participating in this program, veterans have the ability to:

  • Receive an overview of various information technology industries, including a number of career paths.

  • Create a development plan specific to personal skill-sets, interests, and goals

  • Gain an understanding and insight into the corporate culture of globally distributed companies – including effective communication, decision making, and conflict management.

  • Learn to effectively prepare for and execute a job search including company research, resume and cover letter writing

  • Receive a technical education in a specific concentration of their choice, and where applicable, acquire industry certification

The program takes about 13 weeks, after which students have the opportunity to pursue industry certifications. The Veterans Technology Program is presently underwritten in its entirety by JPMorgan Chase & Co. Additional information regarding the application, including requirements, can be found at [Source: Ho Lin article 5 Dec 2011 ++]
Intrepid Project: The U.S. Senate is scheduled to take up the issue of whether the remains of 13 American naval heroes – tossed into a mass grave more than 200 years ago – should be returned to their native land for proper burial with military honors. On Sept. 4, 1804, Master Commandant Richard Somers and his crew were killed in action during the Barbary Wars when their ship, the USS Intrepid, exploded in Tripoli Harbor off the coast of Libya. Their bodies washed ashore and were eventually buried by fellow sailors taken prisoner by the enemy. The issue of whether to remove the Intrepid crew from Libya is a contentious one. Descendants of Somers and his second-in-command, Henry Wadsworth, have been pressing Congress to do whatever is necessary to bring some of America’s earliest war heroes back home. Last spring, The American Legion passed a resolution in support of the move, and the U.S. House of Representatives recently passed an amendment calling upon the secretary of Defense to take action.
The U.S. Navy opposes the repatriation of the Intrepid crew’s remains, citing an official April 1949 ceremony at a Protestant cemetery where several – not all – of the sailors were buried. In a March 2010 document, then-Chief of Naval Operations Adm. Gary Roughead wrote, “Since these remains are associated with the loss of the Intrepid, Tripoli’s Protestant Cemetery has been officially recognized by the Department of the Navy as the final resting place for her crew.” According to Michael Caputo, coordinator of the grassroots group Intrepid Project, the entire Intrepid crew may not be interred at the Protestant cemetery. “Some of the enlisted crewmembers may still be buried adjacent to what is now called Martyr’s Square,” he said. “As for the cemetery itself, it is essentially in a shambles, with shattered markers and grounds that are not being maintained.” The current Chief of Naval Operations Adm. Jonathan Greenert confirmed the Navy’s stand on the issue in a 16 NOV memo that said the admiral “has reviewed and concurs with the previous Navy position of not supporting the proposed legislation.” The memo went on to point out that repatriating the Intrepid crew’s remains would cost between $85,000 and $100,000. “This does not include costs associated with DNA testing and analysis …. Nor does it include the cost for the Navy to contract out genealogical research….”
Sen. Dean Heller (R-NV) introduced a bill S.1497 on 8 NOV to bring Somers and his crew back home from Tripoli. The legislation would require DoD to exhume the remains, identify them and return them to the United States “for military burial.” Fang A. Wong, national commander of The American Legion, sent Heller a letter of support that said, “It is incumbent upon Congress to direct recovery of those remains of Americans within Tripoli. Given the turmoil in Libya, America must take the opportunity to repatriate these remains now.” Heller said that America, “has a duty to ensure that any fallen member of the armed forces is treated with utmost respect. The American Legion has always been a faithful advocate for their brothers and sisters in arms, and on this issue, it is no different. I appreciate their support as we work together to retrieve our heroes from foreign shores.”
In late NOV, descendants of Somers and Wadsworth, and other advocates, visited several senators in Washington to drum up support for Heller’s legislation. Accompanying them was Dean Stoline, deputy director of the Legion’s Legislative Division. Stoline said the group, “lobbied the Senate for two hard days to support their request to bring home the remains of their loved ones and other crew members of the USS Intrepid. I think their request was well received and several senators – such as Sen. Richard Blumenthal, D-Conn. – have now signed on to help push the legislation introduced by Sen. Heller.” Next week, the Senate will debate the National Defense Authorization Act (NDAA). An amendment supporting the return of the Intrepid crew may or may not be part of the final package. The American Legion will keep working with the Senate, urging it to act on the Intrepid crew issue. “Our strategy is simple,” said Tim Tetz, director of the Legion’s Legislative Division. “We must impress upon the Senate the importance of passing an amendment to NDAA that grants the wish of the Somers and Wadsworth families – return their relatives. The House unanimously agreed to this. Now the Senate must do so.” [Source: AL Online Update 1 Dec 2011 ++]

Master Commandant Richard Somers
OEF/OIF Long-Term Costs: The wars in Iraq and Afghanistan may be winding down, but the long-term costs of caring for those wounded in battle are on a path to rival the costs of the Vietnam War. While Vietnam extracted a far higher death toll — 58,000 compared with 6,300 so far in the war on terror — the number of documented disabilities from recent veterans is approaching the size of that earlier conflict, according to a McClatchy Newspapers analysis of Department of Veterans Affairs (VA) data. The data, obtained under the Freedom of Information Act and detailing all disability payments to veterans of all wars, show that veterans leaving the military in recent years are filing for and receiving compensation for more injuries than did their fathers and grandfathers. At the same time, McClatchy found, the VA is losing ground in efforts to provide fast, accurate disability decisions. And the agency has yet to get control of a problem that has vexed it for years: the wide variation in disability payments by state and region, even for veterans with the same ailments. For soldiers coming home from Iraq and Afghanistan, this ongoing variation means the size of monthly compensation checks might be a quirk of geography.
Given the nature of today's disabilities, it's difficult to calculate how much it all might ultimately cost. "We're in somewhat uncharted waters," said Linda Bilmes, a Harvard University professor who has conducted an exhaustive study on the long-term costs of the wars. Her most recent estimates, from 2010, indicate that providing disability payments to Iraq and Afghanistan war veterans could range from $355 billion to $534 billion over the next 40 years; on top of that, costs to the VA's medical system could range from $201 billion to $348 billion to treat veterans of the two wars. For the VA system, that means costs will grow for years to come — even as the country is entering a period of belt-tightening that could reduce the size of government and put a damper on the agency's ability to find the money for these expenses. According to VA and Department of Defense information compiled by the advocacy group Veterans for Common Sense, 2.2 million service members have deployed to one of the wars since Sept. 11, 2001; 942,000 have deployed two or more times. Of those, 6,300 service members have died, and 46,000 have suffered nonfatal wounds in action. But more than 600,000 veterans have filed for VA disability benefits, and more than 700,000 have been treated in the VA's medical system.
"Right now, VA is getting about 10,000 new Iraq and Afghanistan claims and patients per month," said Paul Sullivan, executive director of the National Organization of Veterans' Advocates, which helps veterans file disability claims. "The numbers are devastating." McClatchy analyzed the VA's compensation database, which includes 3.2 million records documenting each veteran and his or her mental or physical disabilities; information that could identify a specific veteran was blacked out. The VA doesn't actually specify whether somebody was in Iraq or Afghanistan, instead lumping all veterans from the first Iraq war in 1990 into a "Gulf War" category. McClatchy zeroed in on veterans who left active duty in 2003 or later, an approximate cohort of Iraq and Afghanistan veterans. Among the findings:

  • Recent veterans are filing claims at a far higher rate than veterans from previous wars or generations. That could make the eventual payout for the VA far higher than for previous wars.

  • The VA's disability payments are still wildly uneven, despite years of attempts to improve consistency. That means, for example, that a veteran who lives in Kentucky is likely to have a higher disability payment than one who lives in South Dakota, often for the same ailment.

  • The speed at which the VA processes disability applications has gotten slower, and the percentage of claims with an error has worsened as well. In fiscal 2011, 16 percent of VA disability decisions contained an error, the VA's own review shows.

The VA said that it is working to do better and that it has hired 2,700 new workers. "We think we've got the problem identified, and we think we have the right disciplines in place," said Thomas Murphy, who directs the VA's compensation program. The true cost of war can't be known for years and decades after the last bullet has been fired. A disability tied to military service might take years to emerge, and might steadily worsen after it does. Bilmes, the Harvard professor who co-wrote "The Three Trillion Dollar War" with Nobel laureate Joseph Stiglitz, said the peak for paying out claims from World War II didn't come until the 1980s. The peak for the Vietnam War, which ended nearly four decades ago, hasn't yet been reached. "We expect to see the same kind of lag this time around," Bilmes said.

Veterans file disability claims with the VA if they've been injured during military service — whether in a combat zone or stateside. Based on the severity of the disability, the VA pays veterans compensation checks that range from $127 to $2,769 a month. Veterans today are applying with greater frequency and greater urgency than in years past. Part of that, Bilmes said, is the nature of these wars. In previous wars, a general seeing a brigade under stress might have pulled it back — putting the soldiers on kitchen duty for a while, she said. Now, those functions are being handled by contractors, eliminating that relief valve. "The guys who are out in the field are relentlessly out in the field," she said. Beyond that, far more soldiers in this all-volunteer military have been back for two, three, four or five tours, and the long-term impacts of hearing loss and traumatic brain injuries caused by improvised explosive devices will be felt for years. Other factors are at play: Better war-zone medical treatment means more injured soldiers come home alive. Veterans are more willing to claim their disabilities than were vets of previous generations, and the VA is more accommodating than it once was. According to VA data, the average Vietnam veteran in the system has 3.5 documented disabilities — more than those from the Korean War or World War II, but less than those in the Gulf War era. Veterans who have left military service since 2003 have an average of six disabilities on file, VA data show. These recent veterans have a combined total of 3.5 million disabilities on file, compared with 3.9 million from Vietnam, McClatchy's analysis shows. While the annual cost of those Vietnam disabilities is higher now, recent vets will see their monthly checks go up as they age.
As it deals with the rush of new veterans, the VA also is contending with an overwhelmed system that is getting slower and sloppier — despite years of promises and efforts to fix it. The VA received a record 1.3 million disability claims in fiscal 2011. The time it took to decide those rose to an average of 188 days. While some award decisions are relatively straightforward, McClatchy found that others — particularly those involving mental illnesses — are subject to wide variation among the VA's regional offices that decide claims. The VA first confronted this problem in 2005, when news organizations reported that veterans' monthly checks varied widely depending on where they lived. The VA pledged to improve its training to ensure consistency among its 57 regional offices. That wide variation still exists, McClatchy found — and particularly for post-traumatic stress disorder, one of the wars' costliest disabilities. For recent veterans who are part of the Louisville, Ky., regional office, 67 percent have a high PTSD rating; 17 percent have the highest rating of 100. For veterans who are part of the Sioux Falls, S.D., regional office, 42 percent have a high rating, and just 1 percent have the highest rating of 100. McClatchy's analysis shows little change in the regional-variation problem since 2005.The VA's Murphy said the agency put in place a new system to guide the regional offices through their disability decision process. That, he said, should help improve consistency. [Source: McClatchy Newspapers Chris Adams article 6 Dec 2011 ++]

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