Veterans & Retirees; Is Government Keeping its Promise This study aimed at exploring the experiences and perceptions of Veterans belonging to Lousiana and Mississippi about three variables; the accessibility of organization; the accessibility of benefits and availability and adequacy of the facilities being provided by government through VA. The respondents were also asked to suggest whether there is a need for improvement and what should VA do to provide benefits and facilities to the Veterans in a better ways.

For this purpose the researcher conducted an online survey targeting 100 Veterans from Mississippi and another 100 from Louisiana. The researcher also conducted an extensive review of the literature focusing on the problems of Veterans as well Government policies and VA structure and healthcare facilities.

Although majority of the Veterans did not give negative response but a great number of responses show that there are problems to access benefits and organization through which veterans can apply for benefits. Veterans perceive that VA is not spending money provided by government in the most efficient manner. The Veterans from Mississippi and Louisiana also suggested that VA should build more VA Medical Centers and also create awareness about the benefits the Government has announced as a great number of Veterans are not aware about these benefits. Veterans also face difficulties in finding organization through which they can apply for the benefits.

Table of Contents

Executive Summary 2

Chapter-1 Problem Statement 7

Introduction 7

Problem Statement 9

Purpose of the Study 11

Research Questions 11

Research Objectives 12

Operationalization of Variables 12

Study Significance 13

Limitations 15

Chapter-II Literature Review 16

Theoretical Framework 16

Impression Management 18

Patient Expectations 20

Service Quality 22

History of Government Benefits for Veterans 23

History of the Veterans Administration 24

Characteristics of the Veterans Health Administration (VHA) 26

Veterans Integrated Service Network (VISN) 27

History and Structure of the VA Service Line 28

Past United States Veterans' Benefits 30

Treating Veterans with Care 31

Veterans Health Administration 32

Common Problems Facing Veterans 33

Veterans Health Problems 36

PTSD: History and Definition 37

Trauma and PTSD Defined 37

Symptom logy 40

Homelessness 41

Risk Factors 42

Post-Traumatic Stress Disorder 46

Depression 47

Drug Abuse 47

Traumatic Brain Injury 48

Housing Problems 48

Veterans and Education 49

Veterans and Unemployment 50

Chapter-III Research Methodology 54

Introduction 54

Research Design 54

Grounded Theory Research 54

Sample 55

Instrument Development 55

Sampling Design 58

Data Collection 60

Data Analysis 60

Chapter-IV Findings 61

Description of the Sample 61

Survey Question-1 what is your Gender? 61

Survey Question-2 What category best describes your current age? 63

Survey Question-3 What is your discharge status? 64

Survey Question-4 What was your Pay Grade/Rank upon discharge? 65

Survey Question-5 What was your branch of Service in the Armed Forces? 66

Survey Question-6 What was your branch of Service in the Armed Forces? 67

Survey Question-7 Is the Veterans Administration doing everything possible to ensure that your needs are met and benefits available? 68

Survey Question-9 Can the U.S. Government improve on both the medical and educational benefits? 70

Survey Question-10 Can the U.S. Government improve on both the medical and educational benefits? 71

Survey Question-11 How easy is it to access the service organizations in your state to help you apply for your benefits? 72

Survey Question-12 Can the Veterans Administration do more to help you receive all your entitled military benefits? 73

Summary 74

Availability 74

Accessibility of the Benefits 75

Adequacy 76

Chapter-V Conclusion 77

Purpose of the Study 78

Summary of the Survey Results 78

Conclusion 79

Recommendations 81

References 83

Chapter-1 Problem Statement

Introduction

Many service veterans served during an active wartime, thus increasing the likelihood of needing VA services. Approximately 25.2 million veterans of the United States uniformed services were living the United States and Puerto Rico and the end of 2000. According to 2000 census of Veteran Population in the United States and Puerto Rico, civilian veterans over the age of 18 living in California was totaled at 2,569,340 accounting for 10% of the general California population over the age of 18. Recent reports document substantial mental and physical health distress and adjustment difficulties among military personnel returning from combat operation in Iraq and Afghanistan. Problems with depression, PTSD, and alcohol and substance misuse are common, particularly among National Guard and Army Reserve Personnel (U.S. Department of Health and Human Services, 2008). As of September 2008, 342,624 veterans were receiving compensation for PTSD diagnosis related treatments...

This issue is especially compelling considering the nation's social contract with its veterans -- "to care for him who shall have borne the battle and for his widow and his orphan" (Lincoln, 1865). Recent political discourse in the United States clearly indicates that this social contract remains very much intact. But the social contract is only as good as the ability of the various public and private health plans to adequately take into account the diverse needs and circumstances of the nation's million veterans.
And, as eligibility and coverage policies of non-veteran programs change, it becomes equally important to adjust accordingly veteran eligibility and coverage policies. The dissertation will focus on the adequacy, availability and accessibility of the services and benefits, Government has promised to provide the Veterans and Retirees.

The concept of access is not one dimensional. In attempting to define and operationalize the term "access," Penchansky and Thomas (1981) note that there are a number of dimensions that comprise this multifaceted concept: availability, accessibility, accommodation, affordability, and acceptability. Availability refers to the actual supply of resources obtainable in the community (e.g., the number of physicians, hospitals, clinics, specialists, etc.). Accessibility refers to "the relationship between the location of supply and the location of clients, taking account of client transportation resources and travel time, distance and cost" (p. 128). The third dimension, accommodation, centers on how the supply of health care and other services is delivered to the client and how amenable the pattern of delivery is to the individual seeking care. An example of accommodation is hours of operation (e.g., care available after-hours or weekends or 24-hour walk-in service). Affordability focuses on the customer's financial ability to pay (either out-of-pocket or via insurance or both) for care. The final dimension, acceptability, is "the relationship of clients' attitudes about personal and practice characteristics of providers to the actual characteristics of existing providers" (p. 129). Additionally, this aspect of access refers to providers' attitudes toward client characteristics.

The Department of Veterans[footnoteRef:1] Affairs (VA) is one of the fourteen federal government agencies in the United States. The predecessor to the VA was established in 1930 to provide healthcare services, benefits, and veterans' services to honorably discharged military veterans. [1: Veteran is any member of the U.S. armed services who has served at least 181 days of active duty, and who is discharged under conditions other that dishonorable, or who is discharged under a medical condition (34 CFR Part 645.6)]

Following WWII in 1946, there was eminent need for expanded healthcare in the country. At that time, a veterans' healthcare system was established more formally under the Veterans Administration's new Department of Medicine and Surgery. In 1988, the Veterans Administration, also known as the Veterans Affairs (VA), was assigned cabinet status, which formally came into effect in 1989. The Department of Veterans Affairs consists of the Veterans Benefit Administration (VBA), the Veterans Health Administration (VHA), and the National Cemetery Administration (NCA).

The Veterans Health Administration is the largest healthcare system in the United States (Evans, 2005) and provides medical care to a large population of American veterans of the armed forces which over 5 million men and women. Some of the organization's objectives are to improve safety, healthcare quality, efficiency, access, satisfaction, and responsiveness (Perlin, 2005).

The number of VHA hospitals around the nation has increased from 54 in 1930 to 159 in 2006 (Oliver, 2007; Veterans Health Administration, 2005). The system operates in over 1,400 sites. Because the VHA is an integrated, publicly financed healthcare system, public scrutiny of quality care and resource management is inevitable. In the early 1990's, critics perceived the VHA's services as poor with limited access, but by 2000, the organization experienced a remarkable turnaround as a result of systems reform that was initiated in 1995 (Longman, 2007; Oliver, 2007; Perlin, 2005).

Problem Statement

The Veterans Administration (VA) was established in 1930 and became the second largest cabinet department March 15, 1989. It provides healthcare, compensation, insurance, vocational rehabilitation, and burial assistance to veterans and their families (Department of Veterans Affairs, 206).

VA requested $36.6 billion to provide medical care to 5,819,000 patients in 2008. Veterans returning from operation Iraqi Freedom and operation Enduring Freedom (OIF/OEF) are estimated to be 263,000 of the 5,819,000 patients (Nicholson, 2007). $38.9 billion is estimated to be received in FY 08 rather than $36.9 billion.

The 2006-2011 strategic plans for the Department of Veterans Affairs (VA) outline the government's commitment to veterans. A goal of the VA is to "deliver world-class service to veterans and their families through effective communication and management of people, technology, business processes, and financial resources" (Department of Veterans Affair, October, 2006).

The VA had significant quality issues until Dr. Kenneth Kizer was appointed Under Secretary for Health in 1994. Dr. Kizer "decentralized the…