TBI Vet Caregivers Would be Eligible for Help

Post date: Mar 13, 2011 1:10:16 PM

Military Times

Posted : Friday Mar 11, 2011 16:20:20 EST

Family caregivers of service members who have suffered traumatic brain injury would be eligible for more support under proposed regulations, Veterans Affairs Department officials clarified Friday.

A caregiver benefits program signed into law in May greatly expands support for caregivers of severely disabled veterans. The most generous new benefits — including living stipends and health care coverage for the caregiver — are provided to caregivers of disabled Iraq and Afghanistan veterans.

“We’re very concerned to hear the interpretation that we wouldn’t be covering traumatic brain injury,” said Deborah Amdur, chief consultant for care management and social work for VA’s Veterans Health Administration.

“Without a doubt, it is our intention that those individuals would be included and eligible,” said Amdur, who testified Friday before the House Veterans’ Affairs Committee’s health panel.

Lawmakers and advocates for wounded warriors and their families said they are concerned that VA’s proposed rules for implementing the new law are too limiting, and would restrict the number of eligible people from the 3,500 originally envisioned by lawmakers to about 850.

VA’s proposed eligibility rules would cover only veterans who would require hospitalization, nursing home or other institutional care without caregiver support providing ongoing personal services at home.

“Many veterans coming home from Iraq and Afghanistan with TBI or PTSD might well need constant care; however they don’t necessarily need institutionalization,” said Tom Tarantino, senior legislative associate for Iraq and Afghanistan Veterans of America. “These injuries and hospital care are not synonymous, and making the need for institutionalization the threshold for eligibility misses the goal of this legislation.”

Under the current criteria, an estimated 750 to 1,000 caregivers of veterans would be eligible to apply, said Dr. Robert Petzel, VA’s under secretary of health.

In a later interview, Petzel said VA is reviewing the eligibility requirements with members of Congress “to see if we can find a way that everybody agrees we meet the intent of the law.”

Although the law required VA to come up with an implementation plan by November and fully implement the program in January, that has not happened.

“Time is of the essence,” because families are frustrated and overwhelmed, said Rep. Ann Marie Buerkle, R-N.Y., chairwoman of the health panel. “They need this now.”

“You have my absolute promise that by early summer we will be paying for caregivers,” Petzel said.

VA missed the deadline because of the complexity of the programs, the effort to get input from those affected and the need for regulations, Petzel said.

He noted that the success of the initiative depends on developing standards that are clear and can be applied consistently, and clinicians must be able to explain to injured veterans why they would or would not qualify for the program.

The National Military Family Association contends another problem is a requirement that caregivers wait for benefits until after the veteran receives a military medical separation date. This “will prevent caregivers from being able to receive training and obtain benefits early enough in the recovery phase to make a difference,” said Barbara Cohoon, government relations deputy director.

Rep. Phil Roe, R-Tenn., questioned the regulation’s requirement that veterans and caregivers be monitored every 90 days. He cited the example of the wife of a wounded Vietnam veteran who took care of her husband for decades. She’s not eligible for Social Security now because she could never work because of her husband’s needs. Roe estimated that she provided more than $1 million worth of care.

“No one visited her home every 90 days. Yet she gave wonderful care because she loved her husband,” Roe said, adding that he does not believe a large amount of program funding should go to pay for such monitoring.

But removing monitoring from the proposal would be “a poor choice,” said Adrian Atizado, assistant national legislative director of the Disabled American Veterans.

Monitoring “is not intended to be punitive,” he said. In fact, civilian caregiver advocacy organizations are aware of the need for monitoring, he said, because sometimes caregivers forget they need to take care of themselves.

After the hearing, Army wife Patty Horan said she is still unclear about whether she would qualify for benefits in caring for her husband, Capt. Pat Horan, who was wounded in Iraq in 2007.

“With Pat, I feel comfortable leaving him a couple of hours at home,” she said, but not for longer periods. After he was wounded, part of his brain was removed, and he has difficulty communicating, reading and understanding, she said. She must be with him when he leaves the house.

Since her husband is still on active duty, “I really don’t know what our financial situation will be,” she said.

What she really needs, she said, is the respite care that the law provides so caregivers can take a break from their considerable responsibilities.

“Respite is huge,” she said.