CVC Program

This program is an initiative from the Department of Veteran Affairs to improve and better manage the delivery of health care to eligible Gold Card veterans.

The main purpose of the program is to minimise hospital admissions by addressing problems early with a view to keeping veterans in their own home for as long as is practical. It is mainly aimed at veterans with complex care needs involving two or more chronic diseases or conditions and multiple care providers.

There is no obligation on the part of the veteran to participate and they can withdraw from the program at any time.

The program co-ordinator, in our case a Practice Nurse, assesses the veteran and compiles a care plan that is then discussed between the veteran and their doctor (GP). Follow up on a regular basis, according to progressive identified needs of the veteran, occurs by either telephone, clinic visit or home visit and ensures ongoing input of a health care worker that is appropriate to the needs of the veteran at the time. The care co-ordinator will liaise with the veterans GP over the year as is appropriate.

The care plan is reviewed yearly or earlier if there is a significant change in the veteran’s health.
This provision of care continues until the veteran either becomes ineligible or decides to withdraw from the program.

At the Hamilton Medical Group, this program is provided by Bev on Thursdays.