Caregiver Support to Veterans

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.

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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

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IF10396

Caregiver Support to Veterans

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