New funds, new focus on female veterans

With new grants for video conferencing on issues like contraceptives and menopause, a mini-residency for nurses to improve how they care for women and a pilot tele-project for maternity care, the Minneapolis Veterans Affairs Medical Center has come a long way.

Even a few years ago, exam tables at the women's health care center faced out into the halls and patients had to navigate a labyrinth of corridors full of men to get to the fourth-floor center.

Female vets seeking treatment has become more common and the way the VA addresses women's health care is getting more sophisticated. Nationwide, the VA now outperforms the private sector in screening female patients for breast and cervical cancers, for example.

The issue has become increasingly important as a new generation of female vets emerges -- the 78 percent who are younger than 40. Women are the fastest-growing subgroup of veterans.

"We've been struggling to keep up and get ahead," said Dr. Erin Krebs, women's health medical director at the Minneapolis VA. "It's the VA's job to care for all veterans, including women -- to be more aware that women veterans are here, they belong here and we provide services to them. It is a culture change over time."

As part of the new effort, the Minneapolis VA was recently awarded $217,000 in grants designed to improve the quality and access of women's health care, part of a nationwide announcement of awards to 33 VA facilities. The grants represent the largest ever one-year total for enhancing health services for female veterans.

The Minneapolis grants include $173,000 to support a women's health tele-pharmacy, which will use video conferencing to provide women-specific services such as contraceptive counseling and menopause management as well as chronic disease management services in an effort to reduce health disparities among women veterans. The Minneapolis VA also received $20,000 for a mini-residency program to be held this year for women's health and primary care nursing staff as a way to update basic skills, and a $24,000 grant to expand a pilot project for a tele-health program for maternity care.

"We are really working to take advantage of the national initiative to increase our resources locally," Krebs said of the new grants.

Recognizing that some female veterans have been reluctant in the past to go the VA for services, the Minneapolis women's health clinic has tried to make itself an increasingly appealing place. Women can get almost all of their care in one area, including primary and almost all specialty care and separate mental health services.

The Minneapolis VA recently hired a care coordinator nurse to handle maternity and cancer care as well as its own specialists in mammography. It also has hired a full-time primary care doctor from private practice for its women's clinic. It is in the process of securing its own equipment to do in-house breast imaging and screenings for the first time.

"The big picture is that we are growing, and it's a result of the increasing demand," said Krebs. "There are increasing numbers of women veterans. They are younger than before; we have an increasing demographic shift."

The number of female veterans using the VA has risen 83 percent in the past decade, from about 160,000 to over 292,000 between 2000 and 2009. That compares with a 50 percent increase in men. At the Minneapolis VA and its 10 community-based outpatient clinics, use by female vets grew to 6,199 in 2012, compared with 4,187 in 2007.

With all the progress, female veterans are still 30 percent less likely to enroll in VA health care than are men. Stacey Hunt, who retired as a staff sergeant in the Minnesota National Guard, has used the Minneapolis VA after filing a disability claim for a broken ankle she sustained while deployed on active duty. She also worked at the Minneapolis VA in 2009 and 2010 as a nursing assistant.

"It's improving but I still think they have a lot of ways to go," she said. "They are making it more comfortable for women, but it is still taking them a long time to make the right appointments for me because maybe my injury isn't so obvious to the eye. I get the runaround. We just kind of get pushed to the back sometimes."

Access to health care will take on added importance in the future. While the male veteran population is expected to fall by 2020, the female veteran population will rise, and make up 10.7 percent of the total veteran population.

"The VA is trying to be more compassionate toward women, but I think they are still just trying to learn," Hunt said. "After all, it's still pretty new to them."

Mark Brunswick • 612-673-4434