Updated February 1, 2017 Caregiver Support to Veterans In recognition of the significant role family caregivers play in providing personal care services and other supports to veterans, the Caregivers and Veterans Omnibus Health Services Act of 2010 (P.L. 111-163) was signed into law on May 5, 2010. The law requires the Secretary of Veterans Affairs to establish caregiver support services to veterans. In accordance, the Department of Veterans Affairs (VA) established the following two programs:  Program of General Caregiver Support Services, which includes caregiver programs for veterans of all eras; and  Program of Comprehensive Assistance for Family Caregivers, which provides additional supports and services to family caregivers of eligible veterans or servicemembers seriously injured in the line of duty on or after September 11, 2001. Congress authorized over $1.5 billion for FY2011 through FY2015 for caregiver support programs; $625 million for FY2016; and almost $735 million for FY2017. Actual obligations for both programs were $31 million for FY2011; $115 million for FY2012; $226 million for FY2013; $350 million for FY2014; $454 million for FY2015; and $622 (estimated) for FY2016. Program of General Caregiver Support Services The Program of General Caregiver Support Services provides the following selected resources and supports to family caregivers of veterans of all eras enrolled in VA health care (for further information, see VA’s Caregiver website at http://www.caregiver.va.gov/). Caregiver Support Line The VA offers a Caregiver Support Line (1-855-260-3274, toll-free) staffed by licensed social workers who respond to inquiries about caregiver services and benefits, provide information and referral to community resources and VA Caregiver Support Coordinators (CSCs), and provide emotional support. In FY2015, the VA received more than 57,000 calls and facilitated about 8,000 referrals to CSCs by the Caregiver Support Line. Caregiver Support Coordinator The VA mandates at least one designated CSC at every VA Medical Center (VAMC). The CSC serves as the primary clinical and subject matter expert on caregiving issues, assists caregivers and veterans in accessing VA and nonVA services and benefits available, and coordinates home visits under the Program of Comprehensive Assistance for Family Caregivers (described below). Peer Support for Caregivers The VA also provides a Caregiver Peer Support Mentoring Program, which connects caregivers to one another to share their experience and provide support. Mentors serve as volunteers with their local VA medical centers and receive training prior to being paired with another caregiver. Caregivers agree to participate for a minimum of six months. VA Services to Assist Caregivers Caregivers may be eligible for up to 30 days of respite care per calendar year, which provides temporary relief to caregivers. The VA offers respite care in a variety of settings, such as a veteran’s private home or through temporary placement of the veteran in a VA Community Living Center, a VA-contracted Community Nursing Home, or an Adult Day Health Care Center. In addition to respite care services, the VA offers a range of long-term services and supports, geriatric, and extended care that can directly assist seriously injured veterans (see CRS Report R44697, Long-Term Care Services for Veterans). Program of Comprehensive Assistance for Family Caregivers The following briefly describes program eligibility, benefits, and VA oversight for the Program of Comprehensive Assistance for Family Caregivers. In FY2015, almost 25,000 family caregivers participated. Veteran Eligibility Post 9/11 veterans and certain servicemembers eligible for the program require, at a minimum, six months of continuous and approved caregiver support that is in the best interests of the veteran or servicemember based on one of the following criteria:  inability to perform one or more activities of daily living (ADLs), such as dressing, grooming, toileting, feeding, and mobility;  need for supervision, protection, or assistance due to a neurological or other impairment or injury (including Traumatic Brain Injury, psychological trauma, or other mental disorders);  have psychological trauma or a mental disorder, as assessed by a licensed mental health professional; or  have a 100% service-connected disability rating with special monthly compensation that includes aid and attendance allowance. In addition, veterans and servicemembers must receive care at home, as well as receive ongoing care from a VA Patient Aligned Care Team (PACT) or other VA health care team. In order to receive personal care service from a family caregiver, veterans or servicemembers may not receive similar services provided by another entity, individual, or program at the same time. https://crsreports.congress.gov Caregiver Support to Veterans Caregiver Eligibility Family caregivers must be 18 years of age or older and a member of the veteran’s family (e.g., spouse, son, daughter, parent, step-family member, or extended family member) or someone who lives full-time with the veteran. Prior to approval, a family caregiver must satisfactorily complete caregiver training and demonstrate the ability to carry out the specific personal care services and other assistance required by the veteran. Caregiver Stipend The amount of the caregiver stipend is based on a methodology that considers the amount and complexity of care required by the veteran and is calculated using the Bureau of Labor Statistics wage rate for a Home Health Aide using the 75th percentile of the hourly wage rate in the veteran’s geographic area of residence. Average caregiver stipends range from $652 to $2,371 per month, depending on the veteran’s assessed level of care. The caregiver stipend is an enhanced VA service and is not considered taxable income. According to the VA, approved caregivers do not have an employment relationship with the VA. Other Caregiver Benefits Family caregivers are also eligible for the following: Medical care: medical care under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) if the caregiver is not entitled to care under another health plan (e.g., Medicare, Medicaid, worker’s compensation, or private health insurance). Counseling/mental health services: mental health services necessary in connection with the treatment of the veteran (e.g., consultation, professional counseling, marriage and family counseling, training); also provides mental health services unrelated to the treatment of the veteran (e.g., group therapy, counseling, and peer support groups). Respite care: up to 30 days annually for respite care services, additional days upon approval; also provides respite care for caregiver training. Travel expenses: reimbursement for a caregiver’s travelrelated expenses (e.g., transportation, lodging, and per diem costs) for a single medical examination, treatment, or episode of care of an eligible veteran, as well as to attend required training. Ongoing Support and Monitoring The VA provides ongoing support and monitoring of the veteran and caregiver’s physical and emotional state, including observing for signs of abuse or neglect, adequacy of care and supervision provided by the family caregiver, adjustment to care in the home, and any signs of caregiver stress. Monitoring is conducted through an initial home visit prior to caregiver approval and periodic home visits to assess the well-being of the veteran and family caregiver. Issues with Implementation A December 2014 Government Accountability Office (GAO) report found that demand for the Program of Comprehensive Assistance for Family Caregivers has far exceeded original estimates, leading to VA implementation issues related to insufficient staff and limited program infrastructure. A 2016 VA Report to Congress stated that VA projected program participation of 4,208 caregivers, with a stipend budget of $98 million in 2015. However, actual 2015 program data showed 24,771 caregivers with a stipend budget of about $388 million. There are no limitations on the number of caregivers eligible, as long as the caregiver and veteran meet the program’s eligibility criteria. In addition to workload constraints, GAO’s 2014 report noted the VA’s information technology (IT) system capabilities provide limited ability to monitor workload data or program effectiveness. This is, in part, due to an IT system designed to manage a smaller program. The VA concurred with GAO’s report recommendations and identified various actions to address them. These actions include prioritizing a new IT system and identifying solutions to alleviate workload burden through changes to program procedures and timelines, as well as identifying additional staffing support. Program Expansion A July 2013 VA report on the feasibility of program expansion stated that such an expansion would allow equitable access to seriously injured veterans from all eras. However, expansion poses significant challenges for the VA in accurately estimating the number of eligible veterans and their caregivers. Moreover, program eligibility determinations may be complicated by limited evidence for serious injuries that occurred in prior decades and the extended time needed for such applications, as well as the staffing and infrastructure to support such an expansion. The VA estimates an additional 2,000 staff would need to be in place to assist with such an expansion. In the 114th Congress, the Senate Committee on Veteran’s Affairs reported S. 425, the Veterans Homeless Programs, Caregiver Services, and Other Improvements Act of 2015. The legislation was subsequently placed on the Senate calendar but did not see floor action. The bill would have phased in expansion of the Program of Comprehensive Assistance for Family Caregivers in two stages. First, by expanding eligibility to veterans with a serious injury incurred or aggravated in the line of duty in the active military, naval, or air service on or before May 7, 1975. However, the timing for this first stage of expansion would be contingent on VA submitting to Congress a certification that is has fully implemented an information technology system that allows data assessment and program monitoring. Two years after VA submits such certification, the program would expand eligibility to veterans in its second stage, to include veterans with a serious injury incurred or aggravated in the line of duty in the active military, naval, or air service after May 7, 1975, and before September 11, 2011. It would also add financial planning services and legal services related to the needs of injured veterans and their caregivers. CBO estimated that implementing this expansion would cost $2.9 billion over the five-year period from 2017 to 2021. Kirsten J. Colello, Specialist in Health and Aging Policy https://crsreports.congress.gov IF10396 Caregiver Support to Veterans Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material. https://crsreports.congress.gov | IF10396 · VERSION 5 · UPDATED