QUESTIONS & ANSWERS
The Caregiver Program has up to 90 days to respond.
You respond to questions that directly relate to the care of the veteran and be clear and brief in your answers. It’s best if the medical records correspond to your answers. It’s advised to NOT respond to questions not directly relating to the care of the veteran, as it’s information not relevant to the assessment.
In VA Directive 1152, it says the payment is due on the first of the month, but not considered late until the 10th.
In the new criteria (active from October 1, 2020), we have not seen scoring criteria.
No, you are not required to live with the caregiver, but realize that the new criteria of ADL support each and every time the eligible disability is performed means it’s an advantage to live with the veteran in the eyes of many staff members.
No; the legacy caregivers cannot have a relocation/address change to retain their legacy status, and will be re-evaluated for consideration into the new location. In other words, you lose the legacy protection even if you change address due to reasons beyond your control. This is a problem currently under discussion, but unresolved as of now (January 2021).
Yes, and according to VA leadership, it will stay in place indefinitely. However, applications and appeals are ongoing.
From your description, it appears that you do qualify, but you must have fully documented the required support needed for Activities of Daily Living (ADLs). In your case, it seems that most of the support falls into the Safety and Protection elements of support. The veteran’s medical records must also document these problems and the treatment plan. If there is outside care, the medical records must be added by the VAMC’s privacy officer and uploaded. Eligibility is based on the criteria outlined in the Directive (resources on our website, Resources/Caregiver Program/MISSION Act), and we suggest you download and print the criteria.
The Caregiver Program is a VHA (Veterans Health Administration) program, and the stipend is paid directly to the caregiver. Regrettably, the stipend does not qualify for social security income; this is a serious flaw in the program, in our opinion.
No, it is not. The only criteria for eligibility are the support needs for Activities of Daily Living (ADLs), including those for Supervision and Protection (important for invisible injuries). Extra tests are not authorized, and opting out of these tests while remaining compliant is best done by printing out the eligibility criteria (our website, Resources/Caregiver Program/MISSION Act) and calmly sharing it with the CSC or person who told you about the OT evaluation. Informed caregivers have the best outcomes.
No, you’re not risking retribution, but carefully testify to only your experiences and don’t embellish. This is a serious and hopefully clean look at problems that are alleged at your VAMC in the caregiver program, and your information may help bring about positive changes. VA cannot know what to fix until they know about it specifically. Still, be sure to be clear and concise, and bring documentation or communication that supports the alleged wrongdoings. You’ll also be asked to sign a document confirming your witness obligations, protections, and privacy matters. We wish you success!
The stipends are due by the first of the month, but are not considered late until 10 days into the month (on Day 11). When delays are later than 1-2 days, a public posting is usually done. Contact this website to see if your payment has processed: https://www.vis.fsc.va.gov. Please plan as best you can for possible delays in payment, especially at year end or holiday weekends.
The appeal process is outlined in the VHA 1041 Directive in our website Resources under the VA Caregiver Program. You must document the rebuttal of the stated reasons for denying the request in the VA letter provided you, and reviewing the criteria and estimated scoring that would earn a tier increase. The level of detail is crucial, and remove all emotion and stories – they most likely will not be read. Bullet point factually the additional ADL tasks as well as Supervision and Protection needs. The latter is often most important for invisible injuries, and often ignored by caregivers focusing on the ADL’s. Keep a copy, follow the Appeal Process, and CONFIRM receipt by the VAMC and the VISN, creating a paper trail. It is possible to affect an increase, but you’ll need to follow the Appeals process carefully outlined in Directive 1041, noting the response times.
Please reach out to the Patient Advocate at the ____ VA (link attached with contact information in detail). Many programs exist for veterans of older eras as long as inpatient services are not required. We also suggest tapping the STATE Dept. of Veteran Affairs, since local resources may be easier and more direct to obtain. Google the Dept. of VA in your state, and begin at the top of the leadership and persist. Few WWII veterans are with us today, and he is fortunate to have you as his advocate.
Based on the information you provided, your veteran has both a documented TBI and PTSD, is undergoing VA treatment, and fits eligibility. It appears that with the documentation, only the ADL assistance has been considered, which you indicate that night terrors, fugue states, and safety issues are his primary needs – these often fall under the Supervision and Protection requirements for the PCAFC program. Document in straightforward bullet point form the tasks you assist with for the “veteran’s wellbeing” and safety – this seems quite clear-cut, and if review the letter provided to you for the REASONS you were denied. The list you have formed now will be clearer and less likely to be denied as they strongly fit the criteria for Supervision and Protection.
We suggest you call the VA Helpline and explain your situation, though you will probably be told the veteran themselves must seek care, unless he’s a danger to himself or others. The National Veterans Foundation has support assistance as well as local resources you may Google: https://nvf.org/. Another is the VA Homelessness line, https://www.va.gov/homeless/nationalcallcenter.asp and ask their assistance. Both schizophrenia and bipolar disorder are complex and need medical care to manage, but it IS possible.
For yourself, there is an excellent resource, www.Vets4Warriors.com. This is a helpline staffed by veterans, milspouses, caregivers, and others who know the military lifestyle and the problems that come with that. They will happily take your call, text, or email and have resources to guide you to additional help. Regrettably, when one person serves in the military, often so do family members. By seeking help for YOU, you will be given tools to manage the stress of your son and his choices. Know you are not alone, and please take care of yourself and your marriage. Being a parent never ends, and you are a blessing to your son. Wishing you the best of success with this difficult problem.
The following is a very long blog post on the VA website: https://www.blogs.va.gov/VAntage/3861/a-note-from-a-caregiver/.
Yes, it IS possible to reapply to the program. When you were dropped, if the reasons were provided, you can emphasize those specific support needs (via documentation on the ADLs and Supervision and Protection). Be sure to proactively cover the reasons you were dropped from the program, not necessarily going into the termination, but making sure the medical documentation, his medical records, and the CATS and PATS records are also in your hands. The latter two are obtained only by FOIA (Freedom of Information Act) request to the privacy office.
There are good videos on our site for both ADL documentation and CATS and PATS, which were probably unknown even that short time ago. They represent additional records from the Caregiver Coordinators and the Patient Advocates. If the proper information is not in his medical records, including any outside-VA care, then to the VA and the program, it doesn't exist and won't be evaluated for eligibility in the program.
Yes, you can call the Caregiver helpline, who will refer you to the local facility, or you can write or call the local CSC for an update. We suggest putting your request in writing and also attach a Read Receipt and put “Pls Confirm Receipt” in the subject line of the email. VA has said that response to inquiries should come within 5 business days, and the response for confirmation of their action on your application takes longer. Confirming receipt is the first step; best of success.
Since you won the appeal on its merits, we recommend you ask for retroactive payment to the original date of the tier reduction since the tier should not have been reduced. However, each VA handles things differently, but this approach is usually followed.
The stipend is calculated using the Bureau of Labor Statistics (BLS) hourly wage rate for home health aides at the 75th percentile in the eligible veteran’s geographic area of residence X the number of hours of coverage (10, 25, or 40 hours) X 4.35.
If you need more information for appeals, or documentation, please go to Resources/VA Caregiver Program on our website. PRINT the Directive 1152, and Appeal process, plus look at the videos on ADL documentation, CATS and PATS, and prepare the detailed documentation necessary if you plan to appeal. If you were NOT given the reasons for revocation, the VAMC is required to give you specific reasons. Also, we recommend you read our blog from September 2018 that explains marking your medical records "sensitive", which tells you who and when someone reviews them, and you can then order a SPAR report to find out that information.
You must correct the medical records with a written document, line by line showing documentation that corrects their errors. This is done through the privacy officer at your VA. See the video on Accurate Medical Records.
This type of questionnaire is very unlikely to be a VA form, and the information in it may be interpreted in also intrusive ways. We suggest stating this there is nothing in the eligibility that addresses these issues, and please may you speak to a supervisor. Follow up with a secure email to the CSC noting your question and cooperation, and request further justification for this information (point to the Caregiver Eligibility directives). If retaliation appears to occur, contact the White House Complaint Line (855-948-2311), open a complaint, and ask that the helpline NOT send this case back to the person causing the problem.
Yes, if your husband is in a military hospital, you have a Recovery Care Coordinator available to you, and your Wounded Warrior program can help you find them. There are 10 Regional Caregiver Peer Coordinators through DoD, and more information on phone conferences and webinars may be found on this webpage http://www.militaryonesource.mil/wounded-warrior?content_id=276551. In our Resources section, we also provide a list of the 10 Regional Caregiver Peer Coordinators and their geographic area of coverage. These are contractors specially selected to work with caregivers and they can explain the services their particular region offers to caregivers.
The timing of your husband’s service may make you eligible for the VA Comprehensive Assistance for Family Caregivers Program; what is more commonly referred to as the Stipend Program. On the VA website, this link (http://www.caregiver.va.gov/support/support_benefits.asp) explains caregiver eligibility and provides the online application if the eligibility requirements are met. You may also call this number for information: 1-877-222-VETS (8387). By entering your zipcode at this link (http://www.caregiver.va.gov/help_landing.asp), the name and contact information for your local Caregiver Support Coordinator (CSC) will be available for local questions. Training is mandatory and a home visit, and the stipend level is determined by the severity of the veteran’s injuries/illness.
A FIRP is a Federal Individual Recovery Plan, and the respective veteran will have been assigned a Federal Recovery Coordinator (FRC) who guides the care team and acts to smooth the transition from active duty medical care to veteran medical care with a FIRP. This link explains the details: http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=537&FType=2. Bottom line: call your FRC and ask for help with a FIRP. It creates a team network of the care team, with VA and non-VA care providers for the veteran (hence the Individual Plan naming).
The only times you are not paid the 90-day severance when being dropped from the program is for fraud (proven) or in the unusual cases of a caregiver being replaced by someone else at the request of the veteran. In the latter, the caregiver fee is paid to the new person and not double paid. Contact your Caregiver Support Coordinator, their supervisor, and the Director of the VAMC where care is received and request these funds in writing.
Yes, there are multiple Aid and Attendance programs, Alzheimer’s support programs, physical recreation programs, and mental health support. Eligibility is similar to the CG program in support for Activities of Daily Living, but will vary depending on which program you are seeking. Funds from this program go directly to the veteran rather than the caregiver. Contact your VAMC and inquire about what is available TODAY for older veterans.
It doesn't and you are not required to obtain these tests as they are not in the law, nor eligibility requirements. You may be told you're uncooperative - you are not, as these are not to be considered for eligibility. Download and print a copy of the June 14 2017 directive and share it with the requesting party.
According to the law, the assessment is conducted by the veteran's primary care team. At some VA's, this is not being done.
This is an evolving issue and please see VA VHA Directive 1188 (https://www.boise.va.gov/docs/Service_Animal_Policy.pdf) or posted in Resources for specifics of service dogs in VA facilities. An emotional support dog is not considered a service animal. This policy is reviewed routinely as the potential for good is clear, but so is the potential for uncertified and unauthorized animals into a medical facility where have been situations of animals being overly aggressive with certified and professionally trained service dogs.
Please see the VA MISSION Caregiver sections 161, 162, 163 in our Resources section under VA Caregiver Program. There is a delay in accepting applications based on the IT requirements in the new law. However, use this time wisely to fully document the Activities of Daily Living you assist with (ADLs) to be ready when applications are opened. Once new VA Directives are issued, we will add them to our Resources.
Contact your VA Caregiver Support Coordinator (CSC) and ask specifically about the respite care offered for your area and situation. Regrettably, many VA’s have limitations on in-home respite care, and please know the options to ask specifically for the respite care offered under the Caregiver Law (in Resources; 2010 VA Omnibus Caregiver Act).
This is a great example of when detail explains what the needs are. If you haven’t already, write all this down, since if the questions are not asked about detail, then assumptions are made. What you describe fits the definition of needing assistance with bathing, but if the right questions aren’t asked, or the vet glosses over the fact that he doesn’t want to say personal details, there is a chance that this will be overlooked. Write this up and ask that the evaluator/RN/PCM add it to his medical records.
Yes, if the eligibility requirements are not met. See the Caregiver Law here: https://www.federalregister.gov/documents/2015/01/09/2015-00071/caregivers-program.
For record completions, please enlist the help of a VSO (Legion, DAV, IAVA, PVA) or use the AW2 advocate (the Army Wounded Warrior advocates). For an appeal, only the records in the official medical record will be used, so having help incorporating and confirming them in the record is imperative.
The caregiver stipend is paid on the first of each month and though you may sometimes receive it earlier, the program uses the first of the month as the payment date. You can always call the VHA office in Denver to inquire about status, and also call your CSC or the CG Helpline.
This one is very hard to nail down since each VISN has some leeway in times from notification to submission of documents for appeal. The local appeal is usually (but not always) 30 days, and the VISN appeal has varied from 7 days to 180 days. The variance is very wide and should be noted on your denial, reduction, or revocation letter (in some cases like El Paso, no days are mentioned). The response can take from 30-45 days from VA and enlist a VSO if record omissions are possible.
This is a challenging issue and receiving counseling or other therapies to address the underlying causes is important. Sometimes the guilt and shame are for lone survivor status, or moral injury, both of which can be helped with therapy and also with complementary therapies like writing, art, therapy animals, and group discussions where there is trust. Here are two videos about forgiveness to help the caregiver; hope they help you: Forgiveness, https://www.youtube.com/watch?v=ZCE5cgum0Ro and Memories and Forgiveness: https://www.youtube.com/watch?v=g689y1Lpsfw.
There are some good part-time, at-home options for caregivers and this is one of the best: https://careers.unitedhealthgroup.com/search-jobs.aspx?kw=remote&lc=&jf=0&inus=0. It would allow you to still cover your caregiver responsibilities and to return to the workforce. There is no hard and fast rule about work and continued inclusion the CG Program. VA’s and CSC’s may vary in their responses.
If you are concerned, try first to reach your primary care doc, another good resource is Vet4Warriiors who can help guide you. The Caregiver Support Line reverts to the VA Crisis Line after 5pm, so someone is always there to take your call. A trip to the VA if close is good, but if your concern is escalating, the closest hospital ER may be a good idea. If you need help getting there, judge whether 911 is wise. VA: (800) 273-8255. Vets4Warriors: (855) 838-8255. Please reach for help as you need it.
Good morning, we understand privacy. On the VeteranCaregiver website, there is a section called Ask Questions Here. We post the questions and give responses with all identifiers removed. That's a safe place. You can email me right on the site or at [email protected]. Glad to answer or find the answer for you.
Contact your AW2 or other veteran advocacy representative at your local VA (usually found under VSO Services). There are abrupt changes taking place and it's not uniform, which means we can't offer you accurate guidance without clear information. Write this weekend and leave a voicemail so you're in the queue. Keep us posted if you need more help.
This is a very tough problem and understanding more about PTSD itself may help you also. Have you read Surviving the Shadows by Bob Delaney? It offers a remarkable outlook to understanding PTSD and the accompanying anger and anxiety. Many, many CG’s are having the same issues, and peer groups will affirm you’re not alone. Please, urge him to get care and perhaps it would help you to talk with a counselor of your own, or contact www.GiveAnHour.org for you. Our radio broadcasts on PTSD – A FAMILY AFFAIR www.Toginet.com/shows/MilitaryNetworkRadio is about family and their experience. Both might help you. Keep the faith; this is not an easy journey, but you can find help for you.
Yes, and please FIRST contact the Caregiver Support Helpline as you’ll be directed there if you haven’t done so already. Contact your AW2 (Army Wounded Warrior advocate) at your local VA or nearby location for help after talking with the VAMC's Patient Advocate. If you write others in the VA system, including the National Caregiver Program Office, keep it tight and succinct, referencing your VA location, your issue, and bullet your previous efforts. Please be sure you've called the caregiver support line FIRST or they will reference you to them as a first step. Best of success to you.
Two issues are in your question. The first issue is needed respite care. Please call the Social Work office at the VA where your father receives care and ask them for guidance and respite help. Also, if you can obtain respite care from other family or friends, church or community organizations for some time off, that would help you now. The second is the difficult issue of authority, and if your brother is listed as your father’s Medical Power of Attorney and empowered to make decisions, then the VA must honor the registered, listed person who holds the legal documentation. If your father was mentally able, he could change that paperwork, but with Alzheimer’s, that’s an uphill battle. We recommend you get the help of a Veterans Service Organization (DAV, VFW, Legion ) to change your status to make these decisions, but this takes time. Be sure that you know the precise document that needs changing, as this is an especially confusing issue, and there are experts at the VSO to help you.
If you are a post-911 caregiver, you may be eligible for the VA stipend program. Go to www.caregiver.va.gov and click on "Caregiver Services for Caregivers of Post 9-11 Caregivers". You'll find information, and a preliminary eligibility questionnaire. You can then download and fill out the Application from the link on the page. You may also call the Caregiver Support Line at 855-260-3274 for more information, and also access your local VA’s information by inputting your zipcode. Once the application is accepted and approved, the VA conducts a home visit, and the approved stipend will begin as explained by the Caregiver Support Coordinator (CSC). Print the Caregiver Fact Sheet here.
Chronic pain is of particular concern because it can cause other problems. Here are some thoughts: Take your documentation, and deliver it to the VA where your husband seeks care. Seek out the pain clinic AND your primary care physician. If you’re distant from the facility, call to speak with the Patient Advocate at that VA. If you can’t find help, contact the National VA Patient Advocate, Keith Pierce ([email protected]). The VA Choice program must respond to you: http://www.va.gov/opa/choiceact/ . If you haven’t received a response please call the Legion representative near you, as they are taking to heart the Choice card response and championing the cause. (www.Legion.org). The point is to touch all the expected chain of command as you move your needs upward. Help is available from the COUNTY Veteran Service Officer where you live: input your zipcode and contact them www.nacvso.org. Same with your STATE Department of Veteran Affairs. There are many programs not otherwise available and big VA would be unaware of most of them. Finally, if there is serious pain and no one answers your calls, emails, or provides you help, you can contact the VA Crisis Line or Military OneSource and they will then send a message to the provider to call you back. You’re in a challenging spot with the expense borne by you to get him care privately, and waiting for reimbursement. We are not benefits specialists and it’s critical to find a VSO to assist you. We have found that the STATE is often faster, and will respond to their constituents.
Here are some organizations and suggestions for you, but please seek out a VSO to assist you since your situation is somewhat unusual, but you are still legally married. Go to www.veterans.ny.gov for the NY State Dept. of Veterans Affairs or call 1-888-VETS-NYS for guidance to programs to help you. If you need help paying the bills, ask about the social assistance from New York at www.needhelppayingbills.com. Non-profits usually assist the veteran, but a faith-based support system may exist near you that may help, along with counseling and perhaps employment support. Social services through the state can provide temporary help and be specific about what you need: transportation, emergency funds, childcare, and employment help. You may also wish to contact www.publiccounsel.org for legal advice.
First, document those missed/cancelled appointments and ask to have the records changed. If that’s not possible, you can also ask for a letter you write to be included in his medical file. Keep a copy for yourself. You can also ask for a change in psychologist, or you can go to a Vet Center which has walk-in mental healthcare if there’s one near you. A change in psychologist is possible if there are others at the facility and ask for the paperwork to begin that process.
You are wise to seek help. If your local area has availability, you can seek faith-based counseling with psychologists who often use a sliding payment scale, especially for military families. A wonderful non-profit, www.GiveAnHour.org, provides free counseling and you can discuss your needs in confidence. Seek a counselor who understands your caregiver role and don’t be afraid to “interview” them to find a good fit.