Topic: Opinions & Commentaries
An article was published in the New York Times on Tuesday November 11th, and although the article does not portray what some of us had hoped for, it did manage to touch on the subject of caregiver compensation. The full article titled; Veterans’ Families Seek Aid for Caregiver Role can be read online @; http://www.nytimes.com/2008/11/12/us/12veterans.htm
Obviously there is a lot more to the story than what was written, so I would like to share some of my thoughts.
First; the article did not clearly explain the reality of what a difficult situation this really is, nor did it offer the current VA regulations and/or the shortfalls with the implementing of those regulations.
As many people may already know; family members are providing the necessary daily care and support to our wounded veterans. Some veterans are awarded Special Monthly Compensation (SMC) also known as Aid & Attendance (A&A) and that may in fact help reduce the financial burden, but more often than not, this compensation is not awarded or does not completely cover the expenses related to providing quality care.
One side of this story comes from those people, like me, who have had to provide aid, attendance and daily support to a veteran who is incapable of living independently. The regulations for A&A are commonly limited to physical impairments, most of which state loss of use (LOU) or the inability to perform activities of daily living (ADL’s), so veterans who can feed, cloth and groom themselves are not awarded SMC. This is often the case of many brain injured veterans who have cognitive impairments, verses physical impairments. Interestingly enough, there is a couple of additional questions on the VA's A&A evaluation form that are commonly overlooked, they read; 1. Can patient live alone? 2. Does patient need another in protecting himself/herself from the ordinary hazards of his/her daily environment? Keep in mind; as in every regulation in the VA, these are left up to the interpretation of a VA evaluator. And just to make myself clear; to date, my son Chris, a veteran who suffered a brain injury and can not live independently, has not been awarded A&A, as we were told by a State VA representative, he was not entitled.
To explain the use of SMC, also known as A&A, I can put it in this simplistic way; the additional award of SMC is provided by the VBA as compensation to allow the disabled veteran the means to pay for the services they can no longer do for themselves, as a result of service connected injuries. A couple examples of how SMC or A&A could be used are; if the veteran can not maintain their own home, SMC affords the veteran the ability to hire someone for those tasks. If the veteran can not travel independently, SMC affords the veteran the ability to hire someone to accompany them.
Another side of the story comes from the family members who are proving 24 hour care. Of all the families I’ve met over the years, the ones that rip my heart out are the families who are providing 24 hour care to a seriously wounded service member. Severe injuries have left many of our wounded veterans incapable of caring for their daily needs, and family members are the ones who are tending to these wounded. Case by case these stories have been told by the media, but I’m not to sure most people get the gravity of what this care entails. Those veterans who have been left with the inability to; walk, talk, feed themselves, or have self control of their bodily functions are at the mercy of those who love them, and in doing so, a spouse, parent or sibling is forced to leave his/her job to provide the necessary care to their loved one. Leaving the entire family to suffer from an adverse economic situations, is just one of the difficulties, most of these family members spend countless hours trying to find good healthcare professionals to help them. In many of these cases finding proper help is impossible and the family comes to the conclusion that they, themselves, are the best option to provide quality care. These family caregivers have developed the critical skills to provide the veteran daily care, but, they have been denied financial compensation for such labor. The alternative to 24hour in-home care by a family member is these wounded veterans would be placed in skilled nursing facilities, which are not only inappropriate for our young veterans, they are very expensive for the VA. One example is the story portrayed, in the NY Times article about the Keil’s, yet another example can be read in the eloquent testimony provided by Anna Frese, about her own family, during Legislative Hearings on H.R. 3051 on Sept 9th 2008. http://veterans.house.gov/hearings/hearing.aspx?NewsID=299 (Mrs. Frese’s testimony is the last on the page)
The Caregiver Compensation we have been hoping for is totally separate from VBA benefit of SMC, and this is where it gets a little confusing to most. VHA benefits will contract and pay for services that need to be performed for the health and well being of a wounded veteran, yet family members who are performing those same services can not currently be paid by the VHA. These families are not a bunch of ungrateful money hungry people; they just want the opportunity to provide the best possible healthcare options for their loved one. In some cases, the best option is for the care to be provided by a family member, and that’s when we want the VA to recognize that service and pay the family member rather than paying an outside contractor. Not only would the veteran get the care they require, the care would be performed with consistency and dignity in a compassionate and loving way.
The third part to caring for our wounded is the need for appropriate respite care. Current regulations only provide relief, to the caregiver, by placing the wounded veteran in a skilled nursing facility or group home. As in the case of Sgt Ted Wade, the only way for Sarah to get a break from assisting Ted, is for Ted to be placed in an outside facility, at a cost of $857 per day. A reasonable and cost effective alternative would be for the attendant services to be provided in Ted’s home. If Sarah Wade or Tracy Keil were receiving Caregiver Compensation they would be able to hire temporary help and actually have the means to pay for those services in their absence.
The cost to the federal government (the tax payer) would be much less for Caregiver Compensation than the current costs of contracting professional health care providers to come into the home. And respite care could be hired, as needed in the home, rather than shipping the veteran off to be cared for. This is not only smart business; it’s the best option to provide dignified and quality care to those, veterans and their family members, who have already given so much.
