VA Stops Dropping Family Caregivers Amid Program Review

The Veterans Affairs Department has temporarily stopped dropping caregivers from a program designed to compensate family members who provide primary care to severely injured troops while officials review the effort.

Designed by Congress to pay caregivers to keep post-9/11 veterans out of long-term treatment facilities, the Program of Comprehensive Assistance for Family Caregivers gives eligible participants a monthly stipend -- some participants receive $2,500 -- depending on the veteran's needs and location. To apply for the program, caregivers must fill out and mail a paper application, followed by a series of phone and in-person evaluations both at home and at a VA facility. If accepted, they're periodically reviewed to see whether they still qualify, and can be bumped to a smaller monthly payment tier or dropped from the program entirely.

Critics of the caregiver program, as it's popularly known, say decisions on who to keep, who to drop and who to accept are inconsistent, at best.

Many participants complain they were dropped or rejected from the program even as their veterans' care needs increased, making it impossible for the caregiver to hold a job outside the home or leave the veteran alone. Others say they were arbitrarily rejected, despite seeming to meet all the criteria, including a requirement that the veteran need help with "personal care functions required in everyday living," according to VA documents.

The three-week review ordered Monday aims to examine why caregivers who say their veterans are still in need of constant help have been removed from the program, officials said in a release. The review comes after an NPR report early this month highlighted cuts to the program at regional medical centers.

"VA is taking immediate action to review the National Caregiver Support Program [another name for the program] to ensure we honor our commitment to enhance the health and well-being of veterans," VA Secretary Dr. David J. Shulkin said in a statement.

"I have instructed an internal review to evaluate consistency of revocations in the program and standardize communication with veterans and caregivers nationwide," he added.

Advocates say the VA lacks a consistent, system-wide evaluation process for making sure those who qualify for the program can access it, in part because mental and emotional injuries can be debilitating but are very difficult to demonstrate in a short evaluation setting.

The inconsistencies, they say, can lead to two veterans with very similar injuries receiving completely different responses from the program, depending on where they are seen and who does the evaluation.

"One of the more prevalent and frustrating stories we hear over and over is a caregiver's inability to prove the monotonous duties they take on caring for loved ones with mental and emotional wounds," said Steve Schwab, executive director of the Elizabeth Dole Foundation, which advocates for caregiver support.

"Evaluating someone for their emotional and mental well-being is much, much different than walking in and seeing that someone has lost limbs," he said.

Another long-term problem with the caregiver program, advocates note, is that it's limited in who it can help by both policy and budget.

The law authorizing the program, which began in 2010, has a limited scope in the kind of care a veteran must require in order to qualify. For example, veterans must need "personal care services" to qualify, although exactly what those services are can be open to interpretation.

Congress allocated $735 million for the program for 2017, which the VA estimated would cover about 36,000 users, according to budget documents. Although the VA initially estimated that only about 4,000 veterans would qualify for the stipend, almost 16,000 had enrolled by 2014, according to a 2014 Government Accountability Office report.

A review by the advocacy organization Veteran Warrior found that about 26,000 caregivers have been removed from the program in the last two years, said co-founder and Navy veteran Lauren Price. Her husband, a Navy retiree who provides care to her for lung problems caused by burn pit exposure and injuries to her hands that severely limit dexterity, was dropped from the program last August.

Price said they are working to get the attention of both top-level VA officials and Congress. She said they hope the review can lead to longer scrutiny and hearings on Capitol Hill.

"We don't believe that a three-week investigation is going to provide any substantial corrective measures," she said. "But more importantly, this is a first step."

Officials with the Elizabeth Dole Foundation estimate there are more than 5.5 million post- and pre-9/11 caregivers in the U.S. Only post-9/11 caregivers currently qualify for the program, although legislation has been introduced to both expand its scope and who can apply. Schwab said there are between 25,000 and 30,000 caregivers currently enrolled.

Schwab, whose organization has long pushed for the review, said officials need to overhaul the processes for deciding who can stay in the program as well as helping those who are currently in the application process. He said that though the caregiver program cannot help every applicant, processes can be put in place to help the VA administer it consistently.

"What's important to realize about a program like this, and about the VA in general, is the VA has to create a program around the limited scope of policy it's been given by Congress and the budget," he said. They need to focus, he said, "on moving people through a process that is uniform, that is focused on the customer, and is communicative."

-- Amy Bushatz can be reached at amy.bushatz@military.com.