VA STANDARDIZING CAREGIVER PLAN BEFORE OPENING TO OLDER VETS
VA Secretary David Shulkin has told congressional committees in recent weeks he supports a change in law to expand the Post-9/11 caregiver program so that its cash stipend and menu of support services can benefit caregivers to severely injured veterans from earlier generations.
First, however, the Department of Veterans Affairs wants to standardize how the Post-9/11 program is administered across more than 150 VA medical facilities supported by more than 360 caregiver coordinators. Toward that end, the VA on Wednesday issued its first policy directive on screening, supporting and dismissing participants for Post-9/11 benefits so the program is more uniform and predictable.
“This new directive,” said a VA spokesman, “provides consistent guidance to the field about eligibility requirements for the Program of Comprehensive Assistance for Family Caregivers, including guidance regarding discharge from the program.”
Veteran service organizations have been pressing for more detailed guidance on proper operation of caregiver benefits. The need became more apparent as VA began discharging hundreds of veterans and caregivers from the program with little or no explanation as to why they no longer qualified for benefits.
The steady rise in revocations sparked a chorus of complaints and congressional inquiries, enough so that on April 17 Shulkin suspended program revocations until officials studied their dismissal policies to ensure consistency and more effective communication with veterans losing benefits.
Samuel Ickes, a former Army Ranger who has traumatic brain injury and post-traumatic stress, testified with his wife Wanda on limitations of the current caregiver program before the Senate Special Committee on Aging June 14
“I just didn’t understand when they told me I graduated from a program,” Samuel said. “Today’s the best I’m going to be…Every day you slip a little more with TBI or PTSD. You’re still going to lose that short-term memory. The issues are still going to be there. Every day is just a little tougher.”
When revocations ceased, about 22,000 caregivers for veterans with severe physical or mental injuries were receiving Post-9/11 benefits, down from a peak of 25,000 in 2015. The program enacted in 2010 provides cash stipends for caregivers based on hours of care required and local wage scales, health insurance if caregivers have none, guaranteed periods of paid respite to avoid caregiver burnout and training to enhance patient safety.
Over the six years of program operations, 11,000 veterans using in-home caregivers had their eligibility revoked, and almost 1800 of these veterans lost or forfeited caregiver benefits more than once, according to VA data.
Forty-one percent of revocations occurred because veterans no longer met clinical eligibility criteria. Thirty-four percent asked to end benefits, sometimes because marriages to caregivers dissolved under the stress and demands of wartime injuries. Fraud or program abuse accounted for 11 percent of revocations. Eight percent of participants lost eligibility for non-compliance, such as refusing home visits. In four percent of cases, caregiver or veteran died. Only one percent of veterans dropped benefit to enter residential care.
The 41 percent tossed from the program for no longer meeting screening criteria raised the most concern among advocacy groups. Too many lost eligibility, proponents argued, because initial VA assessments screened applicants using criteria shaped by limited resources and individual judgment.
Samuel Ickes, a former Army Ranger who has traumatic brain injury and post-traumatic stress, testified with his wife, Wanda, on limitations of the current caregiver program before the Senate Special Committee on Aging June 14
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