VA Must Improve Family Caregiver Program

by Chloe Vickers   |   
5 Minute Read
Caregiver Program

Since September 11, 2001, countless numbers of veterans have suffered serious physical or psychological injuries in service to the United States. Now, they must rely on support and assistance from caregivers, who are often family members. The assistance that family caregivers provide help veterans obtain a better quality of life and contributes to their overall recovery. However, caregivers often encounter financial difficulties due to lost income, and the caregiver role can take a toll on their own physical and emotional health.

Caregiver Support Program

To provide greater support for caregivers of post-9/11 veterans, the Caregivers and Veterans Omnibus Health Services Act of 2010 required the Department of Veterans Affairs (VA) to establish a program to assist these caregivers with caring for seriously injured veterans. In May 2011, the Veterans Health Administration (VHA) — which operates the VA’s health care system implemented the Caregiver Support Program, which included the establishment of the Program of Comprehensive Assistance for Family Caregivers at each of its VA medical centers across the United States. The program provides approved primary caregivers with a monthly financial stipend based on the level of caregiver support that the veteran needs. The program also offers other types of assistance to caregivers, including training, referral services, counseling, some mental health services, and respite care, etc. As of September 30, 2018, an estimated 19,690 caregivers of post-9/11 veterans were enrolled in the Family Caregiver Program.

In 2014, the United States Government Accountability Office (GAO), which operates as the audit, evaluation, and investigative arm of Congress, and exists to support Congress in meeting its Constitutional responsibilities and to help improve the performance and accountability of the federal government for the American people, reported that the VHA had experienced difficulties with implementing the program because it had significantly underestimated the number of caregivers who would apply for and be eligible to enroll in the program.

Specifically, the GAO found that VA Medical Centers (VAMC) had insufficient staff to manage the program, and as a result, some VAMCs had difficulty meeting the department’s timeliness requirements for reviewing applications and making all required contacts with enrolled veterans and their caregivers. The GAO also reported that the VHA’s ability to use the program’s information technology system, the Caregiver Application Tracker ( CAT), for tasks beyond tracking the status of applications was difficult and time-consuming, limiting the VHA’s capability to monitor the program. The GAO recommended, among other things, that the VA implement an IT system that would support the Family Caregiver Program and enable officials to comprehensively monitor the program. As of July 2019, this recommendation had not been implemented. Since 2015, the VA’s Office of Information and Technology (OIT) and the VHA’s Caregiver Support Program Office have jointly worked to acquire new IT system capabilities to replace CAT.

The population of caregivers enrolled in the Family Caregiver Program is expected to increase with the future expansion of program eligibility. The VA John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act of 2018), enacted in June 2018, requires the expansion of Family Caregiver Program eligibility to include caregivers of veterans who served prior to September 11, 2001. However, before the expansion of eligibility can occur, the VA MISSION Act requires the VA to implement an IT system for the program, and the VA Secretary must certify to Congress that the new system will fully support the Family Caregiver Program by allowing for data assessment and comprehensive monitoring by October 1, 2019.
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GAO REPORT TO CONGRESSIONAL COMMITTEES

The GAO was asked to review issues related to VHA’s staffing of the Family Caregiver Program. The VA MISSION Act also included a provision for the GAO to review VA’s efforts to develop and implement an IT system to support the program. The report, published on September 16, 2019, examines the extent to which:

  • VHA has established staffing requirements for the Family Caregiver Program and has data to track program staffing at VAMCs;

  • VHA monitors whether VAMCs are meeting departmental requirements for the timeliness of application reviews and for contacts with caregivers and veterans for the Family Caregiver Program; and

  • VA has implemented an IT system that fully supports the Family Caregiver Program.

GAO CONCLUSIONS

As the VA prepares for the expansion of the Family Caregiver Program to include caregivers of veterans who served prior to September 11, 2001, it is crucial that the VA have an informed understanding of the staffing resources needed to support the program. However, the GAO found that the VA continues to struggle to have the information and tools needed to effectively monitor the Family Caregiver Program. Since the Family Caregiver Program was implemented in 2011, it has experienced difficulties in meeting program requirements, thereby negatively impacting the caregivers and veterans it is intended to support.

Both the GAO and the VA Office of Inspector General (OIG ) have reported that determining and ensuring there are sufficient program staff to support the program is one of VHA’s greatest obstacles in meeting program requirements. In particular, the VHA’s Caregiver Support Program Office lacks complete and accurate staffing data with which to assess current and future staffing levels because it is failing to collect data on all VAMC staff who support the program, and the data collected are not validated. The Caregiver Support Program Office is further hindered in its ability to assess whether VAMCs’ staffing levels for the program are adequate because it lacks system-wide data on the completion of periodic contacts and visits with caregivers and veterans. While the new IT system should address this issue, the GAO determined that the program office would benefit from having an interim method to collect this information as the VA’s previous efforts to fix and replace CAT have not been successful. Until the program office has reliable data for oversight and planning, the difficulties the VA has experienced since the Family Caregiver Program was implemented could be worsened when the program’s eligibility expands to include the caregivers of pre-9/11 veterans. Additionally, and at the great expense of veterans and their caregivers, until the new IT system is implemented and certified, the expansion of eligibility for the Family Caregiver Program will be delayed.

GAO RECOMMENDATIONS

In their report, the GAO recommend that the Secretary of the VA direct the Under Secretary for Health to take the following actions:

  • Collect complete staffing data for the Family Caregiver Program that includes Caregiver Support Program Office funded staff, VAMC funded staff, and staff that assist the program as a collateral duty at each VAMC.

  • Establish a process to ensure that the Family Caregiver Program staffing data that are collected and reported to the Caregiver Support Program Office are accurate.

  • Identify and use an interim method to collect data from VAMCs on their completion of required quarterly contacts and annual home visits with caregivers and veterans that can be used until a new IT system is implemented.

The VA concurred with all three recommendations.

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