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Tom Philpott: Caregiver plan standardizing before opening to older vets

By: Tom Philpott
June 24, 2017 Updated: June 24, 2017 at 2:22 pm
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photo - Tom Philpott - Military Update (Sig 2008)
Tom Philpott - Military Update (Sig 2008) 

VA Secretary David Shulkin has told congressional committees in recent weeks that 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 VA wants to standardize how it is administered across more than 150 medical facilities supported by more than 360 caregiver coordinators. To 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.

Veteran service organizations have been pressing for more detailed guidance on proper operation of caregiver benefits. The need became more apparent as the VA began discharging hundreds of veterans and caregivers from the program with little or no explanation, sparking complaints and congressional inquiries. Shulkin suspended 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 caregiver program before the Senate Special Committee on Aging on June 14.

"I just didn't understand when they told me I graduated from a program," Ickes 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 1,800 of these veterans lost or forfeited caregiver benefits more than once, according to VA data.

Hours before the VA released its new policy directive, Adrian Atizado, deputy national legislative director of Disabled American Veterans, told me "there is no standard process in place." An applicant who qualifies for caregiver benefits at one VA facility might be denied eligibility at another, he said.

Review of the new directive shows it still allows program eligibility to be determined by a VA primary care team, a multidisciplinary clinical team or "an individual VA provider with input from the veteran's primary care team."

VA Directive 1152, dated June 14, is still expected to improve consistency across the program.

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