About 15 years ago, a woman working for Steven Connor, the director of Central Hampshire Veterans’ Services, was commuting to the office through downtown Northampton when she ran into trouble.

The woman had recently returned from a military deployment in Iraq, where she ferried supplies for the Army across the border from Kuwait. There she learned not to drive on the right side of the road — where insurgents would bury improvised explosive devices — but down the middle.

Coming through Northampton Center, Connor said the woman heard something on the radio, her mind returned to a dusty Iraq road, and by the time she snapped back to Main Street, a police officer was pulling her over for driving over the double yellow line.

To Connor, the situation illustrated how anyone potentially working with Veterans needed to understand military service and how it can sit with a person years later.

At a Veterans Affairs hospital, staff members have that training and experience with Veterans, he said. Everyone from the secretary to the physician can recognize the signs of a service member in distress.

In private health care practices, not so much.

In a report published March 14, the Department of Veterans Affairs recommended shuttering its century-old hospital in Northampton, one of just three medical centers it slotted for closure across the country.

The future of the Edward P. Boland VA Medical Center is far from settled. It will need to pass multiple rounds of review by federal officials before its fate is final. But the possibility that it shuts down still has many Veterans concerned.

More than 24,000 former service members rely on treatment at the medical center. If it were to close, some of the hospital’s services would be redirected to VA facilities in Springfield and Connecticut. For urgent care needs, or for the Veterans who hope to receive their primary and specialty care closer to home, the VA intends for community providers to absorb the additional load of patients.

But going to a standard doctors’ office — whether it be the local community chiropractor or Main Street optometrist — is not as simple as it sounds for many Veterans.

“It’s not that they don’t know what they’re doing medically,” said James Oliver, a 65-year-old former military police officer living on the VA’s Northampton campus. “They don’t know us that well.”

After years of Western and Central Massachusetts Veterans getting treatment at a VA hospital, Connor worries many will be dispersed to community doctors’ offices and urgent care facilities where few of their care providers grasp what service members have been through.

Not many health care employees are skilled in working with people who have undergone military training or seen war, he said. Most are not prepared to recognize the effects that remain with a person long after leaving those environments.

“Under stressful situations, [Veterans] are trained to act a certain way, different from everyone else,” Connor said. “If they’re stressed, if their family is stressed in a doctors’ office or in a clinic, to the staff it could look very foreign. But to them, it’s the way they’re trained to cope.”

‘I wasn’t the same person’

When John Paradis, a retired Air Force Lt. Col., returned from overseas, he was elated to see his kids and wife, to sleep in his own bed, to eat a home-cooked meal.

“I thought I was the same man,” Paradis said. “But there were things I didn’t even notice were happening, things my family observed, and they knew I wasn’t the same person.”

Paradis would find himself falling into mood swings, he told a group of health care workers last year as he tried to describe the struggles of reentering a community after going to war. Sometimes he would tear up; other times he would get angry at things he may have previously smiled at or never even noticed.

“When you’re in a deployed environment overseas, you’re extremely vigilant about your surroundings, you’re in that battle mind situational awareness where you’re totally immersed into what’s right in front of you and around you,” Paradis said. “When you come back to your community, and you’re in a so-called ‘benign environment,’ you still have hyper-vigilance tendencies.”

The effects may be short-term for some Veterans. But many others feel the weight of their service long after they return home.

One evening, Paradis and his wife took their kids to the Friendly’s restaurant in Florence. In the booth beside them was a kid just being a kid — jumping around, tapping Paradis on the shoulder.

But Friendly’s was crowded, and in that stressful moment, Paradis was no longer in a family restaurant. He was back on the streets of Kabul or Baghdad or Sarajevo.

“I had a complete meltdown,” he said. “My kids had never seen me like that before and I really scared them and my wife.”

The moments can come with little warning.

He was in crowded, confined Big Y last year when he got that pit in his stomach.

“It felt like the shelves were crashing in on me and people were too close to me,” he said. “I told my very understanding and amazingly loving spouse I needed to leave. I think my words were, ‘Hey I’m not feeling well.’ And she knew. I didn’t have to say anything more.”

Understanding how trauma can interrupt daily life can be difficult for nonVeterans, but a 2017 video from the David Lynch Foundation (linked here) tried to illustrate the idea.

It shows scenes from a Middle East battlefield: a helicopter flying low over the desert, gunshots, mortars, explosions, the hum of a machine gun, the whoosh of a rocket taking off. But then a message comes across the screen — “These images are from the battlefield. The sounds are not. Listen once again.”

Suddenly, the sounds don’t seem so foreign.

The helicopter rotors are a ceiling fan. The gunshots are everything from a washing machine clanging around to a basketball hitting a backboard. The rockets are from the Fourth of July.

“Daily sounds can bring Veterans right back to war,” the video says.

But few public-facing employees can recognize the signs of a Veteran in an uncomfortable situation, Paradis said, and service members may struggle to connect with a doctor who cannot relate to their background.

“It took me some time to find someone for myself outside the VA system who I felt comfortable with,” he said.

‘It’s not the same as the service up here’

James Oliver lives on the VA’s Northampton campus in permanent housing built by Soldier On, a nonprofit providing shelter to otherwise homeless Veterans. He still feels the physical results of his military career.

In a combat training situation in the mid-1970s, he fell into a deep hole and was medevacked out. Between the lower leg damage from that accident and the results of two major car crashes later on, “everything hurts,” he said. “It’s kind of a struggle to get anywhere.”

From the porch of his unit in the Soldier On housing, Oliver can see the medical facilities where he visits a half-dozen providers. At the VA, he has known some of the doctors for more than a decade, and they know about the complications that weigh on him morning and night — ligament damage, spinal injuries, knee and shoulder surgeries.

As the VA has in recent years expanded Veterans’ ability to seek medical care locally, Oliver has seen “some great doctors in the community,” he said. “But it’s not the same as the service up here.”

Oliver trusts the VA doctors to understand military service and military training, to know how it changes a person’s way of looking at the world. He has not seen that level of experience with service members in the community.

“You never know what you’re going to get when you’re out there,” Oliver said.

William LeBeau first began his care at the VA in 2010. It was 15 years past his last service in the Army Reserve and nearly 20 years after he returned from overseas deployment. For years since, he suffered chronic migraines.

“On the civilian side, they would treat the migraine but they were never really worried about the cause of the migraine,” LeBeau, the state adjutant of the Massachusetts Veterans of Foreign War, said.

The VA determined his migraines likely were caused by chemicals he encountered during military service.

“They changed my treatment, rediagnosed me, gave me proper treatment for my condition,” he said. “I felt the VA was just more aware of many Veterans having similar complaints. Your regular doctor may not see another Veteran beside you. The VA would.”

LeBeau was 26 when he left home for the First Gulf War. He had never had asthma — in fact, he could have been disqualified from military service for the condition. Coming home, his breathing was not the same.

“I’ve had civilian doctors tell me I didn’t even have asthma. It turns out many of us who were serving in the Middle East now have asthma who didn’t grow up with it,” he said. “The VA has been doing this for a long time. When you go to a community provider you can get a different perspective and care, and it can be frustrating to many Veterans out there explaining things the VA would know.”

A future yet to be determined

The VA hospital’s closure is far from certain.

Recommendations to shutter the facility emerged in a report by VA Secretary Denis McDonough, the result of a nationwide assessment to “modernize or realign facilities” in the coming years to meet future needs. The study was mandated by the VA MISSION Act of 2018, which passed the House of Representatives and Senate with overwhelming bipartisan majorities before being signed into law by President Donald Trump.

An independent commission will now review the report and make its recommendations for the Northampton hospital and other VA facilities to President Joe Biden early next year. Federal officials, including Massachusetts Congressmen Richard Neal and James McGovern, have pledged to fight to keep the hospital in Northampton.

With the hospital’s ultimate fate yet undecided, LeBeau said his organization was “not necessarily for or against any changes at this point.”

“We need to study it more,” he said. “We’re aware of the proposed changes. Our national office is aware. Our whole goal is to make sure that Veterans can receive the best care they can possibly get and have access to the care.”

“Whether these changes are the right way to go, we’re watching and will try to have some input on that,” he continued. “This is the preliminary report and no decisions have been made.”

Complicating the report, a subsequent finding by the U.S. Government Accountability Office suggested local providers may not be equipped to handle a sudden influx of patients from VA hospitals.

From 2014 to 2020, the number of Veterans receiving medical care in their local communities increased 64%, from 1.1 million to roughly 1.8 million patients, the GAO said.

In examining whether community care providers could treat more Veteran patients, the congressional watchdog said it found gaps in the VA’s data collection during its nationwide review of facilities.

The GAO said federal officials used data that did not reflect the increased number of Veterans eligible as of 2019 to access local care outside the VA. The result, according to the GAO’s assessment, was that the VA lacked “a full understanding” of community care providers’ ability to supplement VA care.

The VA told MassLive that its study of health care facilities across the country, which began in December of 2018, included interviews with more than 1,800 experts. But the VA plans to establish a team to further review its market assessment and to delve into how the COVID-19 pandemic may have impacted the data.

Sarah Robinson, a spokeswoman for the VA Central Western Massachusetts Healthcare System, said that any recommendations about the future of the hospital “are just that — recommendations.”

“Nothing is changing now for Veteran access to care or VA employees. Any potential changes to VA’s health care infrastructure may be several years away and are dependent on Commission, Presidential, and Congressional decisions, as well as robust stakeholder engagement and planning,” she said.

Barely two miles from the VA facilities is Cooley Dickinson Hospital, which would likely absorb more Veteran patients if the VA closed.

Cooley Dickinson spokesperson Christina Trinchero said that the hospital’s leadership would be closely watching the decision and thinking about how to best serve and establish trust with Veterans and military families.

“Working with any specific population with unique needs requires understanding those needs and putting in place systems and training to best serve those patients,” she said. If the VA closure were approved, she said Cooley Dickinson would be proactive in training staff to understand Veterans and their families.

Just Ask

Have you or any member of your family ever been in the military?

That is the question the Western Massachusetts Veterans Outreach Project wants health care providers to ask anytime they meet a new patient. They say the answer may dramatically change how a doctor interacts with and treats a patient.

Connor, the director of Hampshire County Veterans Services, is also a leading member of the Western Massachusetts Veterans Outreach Project, an organization he said has recognized that many public-facing employees — not solely those in health care facilities — do not know how to work with former members of the armed forces.

The WMVOP — whose ranks include social workers, rehabilitation specialists, and many Veterans themselves — has worked for more than a decade to change that. The group has trained probation officers, first responders, and hospital employees on how to interact with and assist someone who may carry the burdens of military service. It has also launched the Just Ask Campaign to prompt health care providers to ask their new patients whether they had military service, so they can approach treatment accordingly.

“You’ve got about two minutes as the provider to gain [a Veteran’s] trust,” said Larry Cervelli, the lead member of the WMVOP.

“If you don’t get it in two minutes, you’ll never see them in a follow-up visit,” he warned.

In a series of trainings in recent years, the WMVOP has discussed with Baystate Health and Cooley Dickinson employees topics including the impact of military culture on mental health and the challenges military families face.

“The VA closure, if it happens, is going to be another shockwave through the Veterans community,” Cervelli said. “We’re trying to get the civilian health care community more efficient and more capable of caring for Veterans.”

Cooley Dickinson Nurse Practitioner Casey Fowler, a Navy Veteran, is also a WMVOP member. She said that “asking the question” can open the door to providing better, more informed care of Veteran patients. As the hospital’s Veteran liaison, she is working to make the Just Ask practice a standard.

“You need to be aware and sensitive to them as a Veteran as well as a patient,” Fowler said. “You listen to all they have been through and need to be aware of their families [and] support system as well. Families often get left out. They are important too.”

As a major in the Army Reserve, state Sen. John Velis, is aware that many Veterans can be hesitant to bring up their military experience. But with a VA doctor, Veterans may bring up concerns they wouldn’t share with another physician, the Westfield Democrat and chair of the Joint Committee on Veterans and Federal Affairs said.

“Providers who specialize in Veteran care do that for a reason,” he said. “It’s a calling. They know the population and speak the language and it’s absolutely critical that we maintain that.”

For some Veterans who now work in health care, the need for more trained civilian caregivers is clear.

Cindy Foster — a Williamsburg resident, paramedic and Army Veteran — was transporting a Veteran at risk of suicide to Baystate Medical Center three years ago when she realized the changes needed to sufficiently treat other Veterans.

In the hospital, she held the Veteran in her arms, trying to calm him down, Paradis recounted in a 2019 column in the Daily Hampshire Gazette. Of the police officer at the door, the Baystate nurse, the attending physician — no one could help.

“Why?” Paradis asked. “Because they weren’t trained in how to relate with Veterans and how to listen — really listen.”

Without knowing military culture and Veteran background, well-meaning caregivers can do more harm than good. Yelling at a Veteran or using physical constraints, for example, can push a Veteran to their limit, Foster said.

She told Paradis: “This is a kind of post-traumatic stress that no one understands until you’ve had it yourself and been there or have had the training or experience in working with Veterans.”

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Including Caregivers into Veterans’ medical teams was the focus of a launch event between VA and the Elizabeth Dole Foundation Jan. 31 at the National Press Club in Washington, D.C.

The Campaign for Inclusive Care Academy is a groundbreaking model for health care systems nationwide, said Sen. Elizabeth Dole, herself a Caregiver for her husband, Sen. Bob Dole.

“We want to equip the doctors, nurses, social workers and frontline medical personnel across the entire VA health system with the latest strategies for integrating Caregivers into their Veterans’ medical teams,” she said.

The training focuses on Caregivers and Veterans receiving geriatric, polytrauma and traumatic brain injury care. Providers learn about three topics: the Caregiver’s journey, the value of clear and mutual communication, and Veterans Health Administration privacy policies. The training fits into VA’s mission to care for those who have borne the battle, said VA Chief Veterans Experience Officer Dr. Lynda Davis.

“This commitment to customer service reflects our longstanding held culture referred to in the I CARE values that the VA has,” Davis–herself a Veteran Caregiver—said. The I CARE acronym stands for Integrity, Commitment, Advocacy, Respect, and Excellence.

Previously, including Caregivers into Veteran care wasn’t consistent. Under the new program, VA medical personnel will ask Veterans if they want a Caregiver included in medical care.

“We all know we sit in with our kids and hear what the doctor has to say, but when you’re an adult, nobody says, ‘Do you need your husband or wife to sit in?’” said Lisa Pape, deputy chief officer of Patient Care Services at VA. She said the VA will now ask that question because Caregivers are with Veterans all the time.

“Most of the advocates for this are the Veterans who want that family member engaged,” said Steven Schwab, Elizabeth Dole Foundation chief executive officer. He said the new program should set a new standard for VA and civilian health care. Schwab said major health care systems such as the Cleveland Clinic, Mayo Clinic and Sanford Health are already following the program.

The program will start with three Veterans Integrated Service Networks, or VISNs. The three are VISN 10, headquartered in Ohio and covering parts of the Midwest; VISN 17, headquartered in Texas; and VISN 20, headquartered in Washington and covering the Pacific Northwest and Alaska. In roughly two years, the program will expand to all VA facilities.

The Campaign for Inclusive Care Academy has several goals. One is helping VA identify Caregivers and make them part of the team. Equipping Caregivers to promote more positive clinical outcomes is another goal. The program also aims to enhance VA’s Choose Home program and improve care in the home. The last goal is to ensure that the information VA receives about Caregivers is respected and remains private.

Background

VA started meeting with the Veterans’ Family, Caregiver, and Survivor Advisory Committee in October 2017. In September 2018, the Elizabeth Dole Center of Excellence for Veteran and Caregiver Research started. The Joint Campaign for Inclusive Care launched in October 2019.

Research published in the June 2019 edition of the journal Health Affairs showed VA and the Elizabeth Dole Foundation’s progress on a Veteran’s health care treatment.

The report was “Including Family Caregivers in Seriously Ill Veterans’ Care: A Mixed-Methods Study.” Duke University led the research and emphasized caregiver inclusion identified in the VA – Elizabeth Dole Foundation’s Campaign for Inclusive Care, which strengthens health care and is a model for improving care in the private sector. The Campaign for Inclusive Care is one of several initiatives and programs through which VA supports Veterans’ caregivers.

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Caregivers of seriously wounded Veterans who were previously denied benefits from the Department of Veterans Affairs may get a new chance to appeal that decision under a court ruling issued this week.

The move has the potential to award tens of thousands of dollars to some families that have struggled to act as full-time caregivers to Veterans, but payouts are still likely months or years away, depending on whether VA officials opt to appeal the ruling.

The case centers on Jeremy Beaudette, a Marine Corps Veteran who left legally blind and and suffering from traumatic brain injury after multiple combat tours in Iraq and Afghanistan. He was rated as 100 percent disabled by VA officials because of those wounds.

But when his wife, Maya, applied for benefits through VA’s caregiver program — which awards up to $2,300 a month in stipends and additional support services to full-time caregivers of injured Veterans — she was rejected. Multiple appeals to department officials were also denied.

Lawyers from Public Counsel’s Center for Veterans’ Advancement and Paul Hastings LLP argued the family should have had the opportunity to appeal that ruling outside that system to the Board of Veterans’ Appeals, which handles other benefits disputes.

But VA officials have long maintained that step is unnecessary, because the program already has several levels of review. They argued that addition of a new appeal will further complicate system, resulting in more confusion and frustration.

This week, the U.S. Court of Appeals for Veterans Claims disagreed with that stance.

A panel of judges on the court ordered those cases be allowed to go before the BVA, and that department officials spend the next 45 days working with the outside attorneys to develop a full list of applicants from the last 10 years who may be owed another chance at appeal.

Since the caregiver program was launched in 2010, more than 400,000 applications have been submitted. Currently about 20,000 Veterans are enrolled. It’s unclear how many of the remainder may have been rejected and exhausted their internal appeals, but now could benefit from the new court ruling.

In a statement, VA spokesman Terrence Hayes said the court’s decision “is a complex ruling with far-reaching implications. The department is diligently considering next steps.”

If VA officials opt not to appeal, families could start being informed of their new application review options in early summer. Attorneys said Veterans affected by the change will be contacted by VA officials about their new appeal rights and procedures, and will not have to reach out to the legal teams on their own.

But if VA does appeal the ruling, it could stretch the case for several more years. Attorneys for the plaintiffs said they hope that doesn’t happen.

“This decision will allow Veterans and caregivers to finally voice the inconsistencies and errors they have experienced with the caregiver program,” says Amanda Pertusati, supervising staff attorney at Public Counsel. “Veterans and caregivers will no longer feel helpless and hopeless, having to navigate within a framework that repeatedly insulates inaccuracies without proper due process.”

The case has been closely watched by outside advocates, who say the long-term effects of the ruling could mean more options for families who feel they were unfairly rejected from the program but also potentially slower appeals timelines.

“Our primary interest now and always is what is in the best interest of our nation’s military and Veteran caregivers,” said Steve Schwab, CEO of the Elizabeth Dole Foundation.

“We’ve long advocated for standardization, consistency, and clear communication across the VA around the [caregivers program]. The foundation is committed to working with the VA and our [Veterans service organization] partners to better understand this decision and the implications it could have on the community we serve.”

If Veterans win appeals cases before the Board of Veterans’ Appeals, those decisions could mean not only future payouts for families but also retroactive pay. Individual financial settlements would depend on the applicants’ initial date of filing and changes in their disability status, among other factors.

Until last fall, the VA caregiver program was only open to Veterans who were injured on duty after Sept. 11, 2001. Congress expanded the group to include Veterans who served before May 1975 last October, and the program is set to expand again to Veterans of all eras in the next few years.

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Veterans Affairs officials are planning to expand caregivers stipends to additional families starting this October, one year after advocates had originally hoped for the financial assistance to be put in place.

About 20,000 veterans — all of whom left the service after Sept. 11, 2001 — are currently participating in the VA caregiver program. The payouts provide thousands of dollars a month in compensation to spouses, parents and other partners of severely injured veterans who otherwise would require expensive institutionalization.

Under new regulations released Friday, department officials said caregivers of veterans injured on military duty before May 7, 1975, would be eligible for the monthly payouts as early as Oct. 1, although when the bulk of payouts would occur remains unclear.

Caregivers of veterans injured between 1975 and 2001 would have to wait two more years to enter the stipend program, under rules previously established by Congress. That leaves those families with a wait until at least October 2022 to enter the program.

VA Secretary Robert Wilkie said the changes “will allow our most vulnerable veterans to stay with their loved ones for as long as possible” while recognizing the complexity of adding up to 41,000 new families to the program in coming years.

The expansion is expected to cost about $3 billion over the next five years, according to previous VA calculations.

The expansion was mandated under the VA Mission Act passed by Congress and signed into law by President Donald Trump in summer 2019. The law is best known for an overhaul of VA’s community care programs, which Trump often refers to as “veterans choice” in campaign stump speeches.

But the caregiver provisions were a major issue for veterans advocates at the time of passage, because of concerns that many eldery veterans had been unfairly excluded from the program.

The program was due to be expanded in fall 2019, but delays in mandated technology upgrades pushed back the initiative by a year.

Under the final regulation, the revised Program of Comprehensive Assistance for Family Caregivers veterans with a service-connected disability rating of 70 percent or higher, regardless whether their condition resulted from an injury, illness or disease.

Monthly stipends are based on federal locality pay rules where veterans live. For a veteran living in Phoenix, for example, the caregiver of a veteran unable to live without full-time assistance would receive about $2,700 a month, and a caregiver of a veteran who needs only partial help would receive about $1,700 a month.

Department officials said they will also provide new training for staff and caregivers, to include financial planning and legal services for families.

The caregiver support program already provides eligible recipients with peer mentoring, respite care, and other support services. More information is available on https://www.va.gov/family-member-benefits/comprehensive-assistance-for-family-caregivers/.

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As she became one of the 53 million Americans who provide care for a family member with special needs, she was so burned out she was "already toast."

I got married at 26 and we were both healthy. You just don't think about severe illness coming down the line when you make the vows. But caregiving, in some ways, is coming for us all. People are living longer and living through more severe illnesses.

During the crisis, on my drive from the hospital to home, I would sometimes think, “God, I could just get out of here” because the relentless pressure of every single day and the very painful sight of Brad being so sick added up to a wish for escape. In reality, I didn't want to actually leave my children and abandon everything. But it was a tempting fantasy.

When Brad came home, the biggest shock to me was being expected to do all this medical work with very little training. There's home care that has to be done and there isn’t insurance support for having somebody provide that, so it falls on family members. It’s a cost-saving measure for the health care system.

Hospital discharge instructions can be really complicated and entail a lot of hands-on care that most people don’t envision. The average person, when they think about a loved one becoming ill, is not thinking about personally administering IV medications through a port. You think, “Oh, a nurse will do that.” But you come home and there's no nurse to do that, so you become the nurse.

The training was handled by outside services that came in, so we also suddenly lost contact with the care providers who we knew really well. I was being trained by somebody unfamiliar and it felt very disorienting.

At one point at his worst, Brad’s chances of making it were only about 10%. The fear of loss was so strong and the ongoing strain of being his caregiver was so high that I walled off my feelings. He was so changed from the husband that I knew. I had to stick to what I promised and do my duty because in some ways I couldn't bear to feel all the feelings that would come up if I let them. So at times, I became a little bit robotic out of a feeling of self-protection.

I felt constant pressure to be sunny and upbeat. There's a strong culture of positivity around cancer in particular — “You've got to stay positive for him.” I found that pressure hard to take. I wanted to retain control over my emotions and how I was feeling. It was tough to feel positive when he was as sick as he was.

I found the “You got this” — some of the more glib kind of illness messaging — a little challenging. The saying I disliked the most is “Everything happens for a reason.” Because this did not happen for a reason. This is just terrible luck, at least according to my worldview, and it can be really hard and feel almost blaming to hear “this happened for a reason.” And it's like, well, what's the reason? What did we do to deserve this?

I definitely heard quite a few alternative medicine suggestions — including that Brad should try turmeric or essential oils. I was able to understand they're well-intentioned. People don't understand the severity of things. They've heard about something that might help, so share that almost in panic or a desire to help.

I went on antidepressants when Brad was in the hospital. Drinking alcohol was definitely something I've talked to mental health and health care professionals about and cut back. I'm certainly not drinking as much as I was when he was very ill, but it was something that I started to look at and think, I should probably rein this in before it does become a problem.

If people want to help a caregiver, I really appreciated a text that just said, “I'm just thinking of you. No need to answer if you're overwhelmed.” Offering to bring a meal is definitely a classic. When you're running to Target, texting “Can I pick something up for you?” can be really helpful.

My husband is doing quite a bit better now — he is disabled and has ongoing chronic illness that requires treatment fairly often, but he's in remission from the cancer — and so my role as a caregiver has kind of receded. It's a little bit more of partnership. My burnout has eased considerably.

It is so hard to imagine, until you've gone through it, how overwhelming really severe illness can be. We can try to convey what caregiving or experiencing that kind of family crisis is like, but I don't think it really hits home until it comes to pass.

We need supports to make that sustainable for the family members who support people through those crises. We can do this better for the caregivers of the future who are going to number in the ever-growing millions.

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Veterans Affairs Secretary Denis McDonough said top officials will re-evaluate ongoing changes to the department’s caregiver support program which could take away stipends from thousands of families over the next year.

“I am worried about the feedback we’re getting,” McDonough told reporters at his monthly press conference on VA issues. “We work for caregivers, we work for the Veterans. We want to make sure that they’re getting the information they need and clarity about why we’re making the decisions we’re making.”

Earlier this month, a coalition of 15 Veterans service organizations presented formal objections to planned department changes in the Program of Comprehensive Assistance for Family Caregivers, which provides stipends to family members who provide home care to elderly or infirm Veterans.

Among the complaints were that the new rules “drastically changed the program’s eligibility criteria” resulting in “harsh impacts” for families.

About 33,000 individuals are currently enrolled in the program, which provides support services and monthly stipends to caregivers of Veterans unable to perform basic self-care activities.

The stipend is set to expand in October to include families of Veterans who served between the Vietnam War and the Afghanistan War, prompting the department work to ensure that existing program participants are being treated equitably.

VA officials announced last fall that they expected around 6,700 families would be dropped from the program under the changes, but that no families would see any financial payouts decreased or ended before October.

The idea was to ensure that individuals would have time to prepare for the financial impact of losing the stipends, which can total more than $3,000 a month. But advocates objecting to the changes have nonetheless called them too restrictive and unforgiving, aimed more at culling families from the program than balancing Veterans’ medical and emotional needs.

McDonough said that in coming weeks, Deputy Secretary Donald Remy will head up a review on the work so far “to make sure that we’re learning everything we can from and that we’re making best use of investments Congress has made in this program.”

On the criticism the department has received, McDonough said he is unsure if it represents widespread communication problems with staff and participants, or simply a small minority unhappy with the personal impact on their families.

The secretary said officials do not have authority under the law to include Veterans with non-service injuries (individuals must have a VA disability rating of 70 percent or more to qualify) but do have more flexibility in how they evaluate whether full-time caregiver services are needed to improve a Veteran’s quality of life.

He expects Remy’s review to take several weeks, and look both at changes to the program and how they are being communicated to the families involved.

“[Caregivers] will be a bigger part of the backbone as our aging Veterans demonstrate that they, like the rest of the country, want to age in place,” he said. “And so we want to get this right.”

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LUBBOCK, Texas (KCBD) - A Lubbock family will spend Veterans Day remembering their fallen husband and father, sharing his story through programs offered by Covenant Medical Center’s Operation Military Appreciation Committee.

With donated display cases, the OMAC recognizes the service of caregivers or patients by allowing them to place military mementos inside. It’s known as the “featured fighter," one of many OMAC programs. Ahead of Veterans Day, the Garza family arranged photographs, uniform patches and more items belonging to their loved one, Army Specialist Israel Garza, who died in an ambush in Iraq in 2004.

“[The items] have a deep meaning,” Israel’s wife Lupita said. “It shows the last day we were together we were able to hug, kiss. He was able to hold his boys for the last time.”

Lupita is a Clinical Program Assistant for Covenant Health Partners. She was nominated and selected by the committee to share the story of Israel through the display case.

“I think it’s a blessing and an honor and privilege to have the hospital continue his story and honor him like this,” Lupita said.

OMAC will unveil the display case during a Veterans Day celebration at Covenant Medical Center on Monday.

“We want to honor them in the best way we can and we do that in different ways,” OMAC Chair Connie Gonzales said “It’s to make sure they know that we appreciate what they’ve done for our country.”

In 2017, National Geographic aired a miniseries about Israel and his platoon called the Long Road Home. A book about the series, as well as the helmet used in the film will be in the display case.

“For us as a family, it’s sad but at the same time it’s an honor to have his story stay alive,” Lupits said “I know my sons love that we get to still talk about their dad and his spirit is still alive. They see that his sacrifice wasn’t in vain. It meant something.”

For Israel’s son Michael, he holds pictures and stories of his father close. He was very young when is father died.

It is tough not having a memory of him, not knowing what he looks like but that’s why we have the pictures and good stories," Michael said.

Israel’s namesake son, Israel Jr., will carry on his father’s sense of service. He just recently enlisted in the Marines.

“I honestly feel like he would be really happy seeing me filling out the papers to enlist,” Israel Jr. said. “I wanted to be a part of something bigger than me. I wanted to achieve something that was high.”

Lupita says seeing her son enlist is bittersweet.

“There’s fear because when Israel left, it was just a peace keeping mission,” Lupita said. “We never thought it would happen and, of course, no mother wants that for their child. But, I am proud of him. I’m happy he’s following in his dad’s footsteps. His dad was the same. He had no fear.”

The “featured fighter” display case will be in the lobby of Covenant Medical Center.

“We have sacred encounters with our patients but we also like to have them with our caregivers,” Gonzales said. “It just brings meaning to what we do here in the hospital, taking care of others and serving others.”

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New commissary and exchange customers will be granted on-base access in two phases, based on whether they have a Department of Veterans Affairs health insurance card, according to new information released by the Pentagon.

The VA and Defense Department have fleshed out some of their plans to let 4.1 million new customers enjoy access next year to commissaries, military exchanges and recreation facilities located on secure military installations.

Here's what the latest plans mean for eligible Veterans and their caregivers:

Am I eligible? Where can I shop when it comes into effect?

Purple Heart recipients, former prisoners of war, Veterans with any service-connected disability and caregivers registered with the VA's Comprehensive Assistance for Family Caregivers program will be able to shop beginning Jan. 1. Reserve members who fit this description will also have access.

These Veterans and caregivers will be able to shop at commissaries and exchanges and use some MWR facilities, such as golf courses, bowling alleys and movie theaters. Services that rely on appropriations to operate, including military uniform items and child development programs, will not be available.

The DoD has been working with the VA, Department of Homeland Security and U.S. Treasury to give these new customers access, integrating them into the complex security systems of military installations.

Retired service members, Medal of Honor recipients and Veterans with a service-related disability rating of 100 percent will continue to have access to on-base facilities and can obtain a DoD identification card to get on base.

I'm an eligible Veteran. What do I do to get access?

Veterans with a VA's Veteran Health Identification Card (VHIC) will be able to shop online and get on base to shop in-person at commissaries, exchanges and some MWR facilities.

Veterans who don't have a VHIC will be able to shop only online, with access to MWR online and AmericanForcesTravel.com, until the DoD figures out how to give them secure access to bases, officials said.

"When DoD and VA identify a credentialing solution for all Veterans eligible under the Purple Heart and Disabled Veterans Equal Access Act of 2018," the guidance states, "DoD will roll out a new phase of access to accommodate current Veterans who are not eligible to obtain a VHIC but are eligible for these privileges."

Currently, all honorably discharged Veterans can shop online through the Veterans Online Shopping Benefit. They can set up an account for any of the military exchange websites: Army and Air Force Exchange System, Coast Guard Exchange, Marine Corps Exchange, Navy Exchange Command, and the Veterans Canteen Service.

Veterans with a VHIC can check in with the base visitor control center to gain base access beginning Jan. 1.

Everyone will have to pass a basic, on-the-spot background check with initial access, and have an automated check each subsequent time. Veterans or caregivers with felony convictions, felony arrest warrants or derogatory information related to criminal history or terrorism will be prohibited from entering.

Depending on the type of installation, these VHIC-carrying Veterans will be able to enroll in recurring access, which lets them bypass the visitor control center each time by entering through the gates.

What is a Veteran Health Identification Card and can I use a Veteran Identification Card?

VHIC cards are issued to Veterans enrolled in VA health care. In order to use the VHIC, it must display the Veteran's eligibility status, like Purple Heart, former POW or service-connected disability.

The VIC is issued to any honorably or generally discharged Veteran and is not an accepted identification to provide access to the installations.

More information about the VHIC card can be found at Va.gov/healthbenefits/vhic. The guidance states the VA expects it might see an increase in the number of Veterans requesting consideration for service-connected disability ratings and applying for health care benefits to obtain a VHIC.

What is the process for a caregiver?

The process for caregivers registered in the Program of Comprehensive Assistance for Family Caregivers to access the commissaries, exchanges and MWRs is similar to that of VHIC-holding Veterans. However, caregivers will receive a letter issued by the VA Office of Community Care saying they qualify as a primary family caregiver of an eligible Veteran.

To be admitted on base and to purchase items from the commissary or exchange, they will need to bring the VA letter plus one of the following types of identification. For a full list, refer to the guidance on page 8.

• DoD common access card
• REAL ID-compliant driver's license or other ID issued by a state, territory, possession or the District of Columbia
• U.S. passport or passport card
• Foreign passport bearing an unexpired immigrant or non-immigrant visa or entry stamp
• Federal personal identity verification card
• VHIC
• Transportation Worker Identification Card

Within 30 days of receiving their eligibility letter, caregivers will be able to shop at the exchanges online like non-VHIC holding Veterans, except for the Veterans Canteen Service.

Caregivers who are not a part of the VA's official program do not qualify for shopping privileges. The DoD might expand access to non-registered caregivers in the future, the policy says.

Can my spouse shop on my behalf?

No, at least not right now. Currently, an authorized caregiver will be classified only as someone approved and designated as the primary family caregiver of an eligible Veteran under the Program of Comprehensive Assistance for Family Caregivers.

The DoD said in this new guidance it will consider expanding caregiver privileges to the disabled Veteran's spouse when the VA formalizes approval and designation of general caregivers under the program.

In the meantime, there's nothing to stop a spouse from getting a base visitor pass and going to the store with the Veteran. However, like all base visitors, they will need to pass a background check.

I already have access to shop in commissaries and exchanges. How will this affect me?

The guidance states most locations will "experience little to no impact on current operations," but there might be a "low to moderate impact" to installations in high cost-of-living areas.

"Commissary, exchange and morale, welfare and recreation retail facilities are preparing to welcome home these patrons without disrupting the current service experience for authorized patrons," it states.

What will it cost me?

The commissary sells its grocery items at cost and boasts "an average worldwide savings of 23.7 percent over commercial grocery shopping." While it has no state or local food tax, it imposes a 5 percent surcharge meant to help with store upkeep and construction of new stores.

As required by the Act, these new customers will have to pay an additional charge if they use a commercial credit card or debit card. These credit cards or a Signature debit card will result in an additional 1.9 percent user fee, while other debit card transactions will have a 0.5 percent user fee. This fee will not be refunded when returning a product.

Veterans and caregivers can avoid these fees by using cash, check or the credit card offered by the military resale system, the Military Star card. Customers using electronic benefit transfer cards, like Supplemental Nutrition Assistance Program benefits, will also avoid the fee.

There will be no such charge at exchanges or for MWR purchases.

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If you’re one of those Veterans who have new shopping benefits on military bases, and wonder if you’ll be able to bring along your spouse.... it depends.

Defense officials maintain that these new shoppers are allowed to bring their spouses and others with them, if they follow screening and security procedures, with certain caveats based on security needs.

By law, and as DoD policy reflects, spouses and dependents aren’t authorized the new benefit, so for example, they can’t purchase anything in commissaries, exchanges, or in morale, welfare and recreation facilities. "However, they may accompany a member of the newly-eligible patron groups [eligible Veterans or caregivers] onto the installation and into authorized facilities,” said DoD spokeswoman Jessica Maxwell, in a response to Military Times’ questions.

But that doesn’t mean it’s happening at every installation. Since the new benefit began on Jan. 1, some Veterans have contacted Military Times asking why their spouses were not allowed to come with them on installations. These Veterans understand that their spouses don’t have the shopping benefit and can’t buy anything. But they questioned why bases are veering from DoD’s consistent statement that spouses are allowed to come on base with them, following required procedures.

The new benefits were authorized by law for all Veterans with VA service-connected disability ratings; Purple Heart recipients; Veterans who are former prisoners of war; and primary family caregivers of eligible Veterans under the VA caregiver program.

According to the Purple Heart and Disabled Veterans Equal Access Act of 2018, these populations are now entitled to access to commissaries, exchanges and certain morale, welfare and recreation facilities on the same basis as military retirees.

There’s an important caveat. Maxwell noted that even if the accompanying guest provides the proper credentials to get onto the installation, installation commanders might still temporarily limit or restrict these guests’ access onto the base, depending on the situation. The installation commanders still have the responsibility and authority to take needed and lawful steps “in their best judgment to protect installation property and personnel,” she said.

Everyone understands the need for additional security measures, said one Veteran whose wife was denied access at Naval Air Station Jacksonville in Florida. This new benefit for about 4.1 million potential new customers took effect just before military officials around the world were implementing heightened security measures as a result of tensions between the U.S. and Iran.

But many question why spouses aren’t even given the opportunity to undergo the credentialing and background checks required for all guests to enter the military installation.

One Veteran told Military Times that the procedure for getting access to Marine Corps Air Station Miramar was easy for him, but he was not allowed to bring his wife into the gate with him. This was on Jan. 2, before the heightened security measures took effect.

Miramar officials referred questions to Marine Corps Installations Command, who didn’t confirm what the policy is at Miramar or where it originated. “We are ensuring we abide by guidelines put forth by DoD, Veterans Affairs and other partnered agencies to properly welcome our new patrons,” said MCIC spokesman Jeku Arce. “We appreciate our new patrons’ patience as our installations adapt to the new policy changes and follow proper physical security procedures to ensure the safety of those who work and live on our installations.

”Please keep in mind that force protection measures can change at any time for various reasons which can impact access to DoD installations."

On Jan. 16, the Veteran contacted Military Times to say he was told the Miramar policy had changed, and his wife would be allowed to come on base with him.

While some bases have told Veterans their restriction is temporary, at least one other base has published a statement saying spouses and other guests don’t have the right to enter the base. “The new legislation does not grant escort or sponsorship privileges,” according to a press release issued by MacDill Air Force Base, Fla, home of U.S. Central Command, U.S. Special Operations Command and dozens of other military tenants. It states that eligible Veterans and caregivers who are granted access to the installation and to base amenities “will not be able to bring family or members or guests with them them” unless those people have base privileges through their own Veteran or military-affiliated status.

Commissary, exchange and MWR officials have no control over security procedures at installation gates. Commissary and exchange officials allow guests to accompany authorized shoppers, and check IDs of those who make purchases.

Here are the current rules for these new customers who want to bring guests with them:

*Stop at the installation’s visitor control center for the required security check, including verification of identity through a document such as REAL-ID compliant driver’s license, passport, etc.; and an on-the-spot criminal history and terrorism checks.

* Guests must remain with their sponsoring Veteran or caregiver at all times, and in retail facilities, but they don’t have access to the benefits, such as making purchases.

*If the installation has credential enrollment capabilities and the guest presents a credential that can be enrolled, the guest can be enrolled for recurring access to avoid having to stop at the visitor center each time. However, the guest can only enter the installation when accompanying their eligible Veteran or caregiver.

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As the U.S. continues its race to vaccinate as many people as possible, the House has passed a bill that would grant the Department of Veterans Affairs the authority to vaccinate all Veterans and their caregivers.

It is unclear how quickly the department could distribute the vaccine, but the measure would dramatically expand the scope of who the VA can vaccinate to include all caregivers of Veterans enrolled in various VA programs, and Veterans living abroad who rely on the Foreign Medical Program. There are about 9 million Veterans enrolled in VA care, but there are 18 million total U.S. Veterans, according to the U.S. Census Bureau.

Yet VA would serve as another option for Veterans and their civilian caregivers, as some people are still struggling to find a vaccine or are confused amid conflicting information on eligibility.

The VA Vaccine Act was unanimously passed by House members Tuesday night and now heads to the Senate, where the leaders of the Senate Veterans Affairs Committee have introduced a similar measure.

Mark Takano, D-Calif., the chair of the House VA committee, said that time is precious as the nation still struggles to get the virus under control. Older generations of Veterans are in a high-risk pool, he added.

"We don't have time to waste -- frankly, I'm worried that any delay in passing this legislation may force VA to turn away decorated WWII Veterans," Takano said in a statement.

According to VA, the agency has fully vaccinated about 1 million Veterans, employees and federal partners. VA data shows 78 percent of Veterans are overweight or obese, which puts them at higher risk of severe illness from COVID-19, according to the Centers for Disease Control.

Veterans are sometimes ineligible for VA care because they do not have a service-connected disability or they have incomes above the department's threshold.

Yet the House bill notes that priority will be given to those enrolled in VA care. It is unclear in the legislation how those who otherwise wouldn't qualify for care would be vaccinated and added to the VA's existing distribution system.

"After such a difficult year, stories of vulnerable Veterans being denied life-saving vaccines from VA are painful to hear," Mike Bost, R-Ill, the top Republican on the House VA committee, said in a statement. "The bill gives VA the authority it needs to meet this moment."

The VA may also have to work to counter vaccine skepticism, especially among younger and healthier Veterans and their families who are relatively safe from the worst symptoms of the virus. Nearly one-third of U.S. troops currently serving have refused the vaccine.

In a straw poll of 810 active-duty military personnel, spouses and Veterans, more than half of active-duty families, or 53%, said they did not plan to get the COVID-19 vaccine, citing safety concerns and suspicions over development. Nearly half of Veteran families agreed.

The CDC on Tuesday released preliminary findings that fully vaccinated people appear less likely to carry the virus and infect others who could be vulnerable. The findings also noted that a growing vaccinated population could lead to swifter lifting of virus restrictions.

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HR 2526, S.O.S. Veterans Caregivers Act, will merely change the semantics regarding the satisfaction that caregivers and veterans experience. With the subtle adjustment in language, it will clear up gaps in any idiosyncrasies which may be interpreted differently and cause confusion within the Caregivers and Veterans Omnibus Health Services Act of 2010.

Please contact your elected officials and ask for their support.

TAKE ACTION

The Scoggins Family Felt Lost Until Resources For Veterans And Caregivers Changed Their Course.

It took Jacqui Scoggins several years of marriage, the loss of her career and an ongoing struggle to keep her family afloat before she realized that she wasn’t just a wife on the verge of divorce; she was a caregiver in need of a lifeline.

“I was at my breaking point,” Jacqui said. “I knew there was something wrong, and I was trying to fix our whole life together.”

Robert Scoggins was an Air Force combat search and rescue pilot.

“I did Iraq, Afghanistan, Africa, 252 combat missions, 251 pickups and 151 lives saved,” Robert said, sharing his story in Washington, D.C., with Jacqui and service dog, Jefe, by his side. Saving himself, however, proved more difficult. Robert returned from war with invisible wounds, including PTSD and traumatic brain injury, that not only put his own life at risk — but jeopardized his family’s well-being, too.

The couple's experience, while unique to their situation, is far from an anomaly. In fact, according to a 2014 study commissioned by the Elizabeth Dole Foundation, there are no fewer than 5.5 million Veteran and military caregivers like Jacqui across the United States, each on a journey that can feel isolating and overwhelming. Like Jacqui, many family members of Veterans may not even realize that they qualify as caregivers. Too few know what to expect, and far too many experience frustrations with health care systems, as well as a lack of resources, self-care and community to help them along the way.

After his third deployment, Robert went through a divorce with his former wife and a battle for parental rights, coping externally with his post-traumatic stress disorder and suppressing his problems. After meeting Jacqui, Robert continued to self-medicate and exercise poor impulse control. He ultimately attempted suicide before accepting and receiving the help he needed to survive.

Every Veterans Day, Americans celebrate heroes like Robert without realizing the extraordinary cost of their service. At the same time, most people rarely think to celebrate those who go the furthest to save the country’s heroes: caregivers and family members like Jacqui who support them every day. The Elizabeth Dole Foundation, which calls these individuals hidden heroes, is devoted to empowering and recognizing and supporting their influence across the nation.

According to Steve Schwab, CEO of the Elizabeth Dole Foundation, the Foundation-commissioned study that first uncovered a national military caregiving crisis also called for more research. More work needed to be done to understand types of support that caregivers need and the circumstances when they need it most.

“We didn’t know enough about what was happening in the homes of these caregivers; we desperately needed insight into the daily challenges and experiences that were shaping their lives,” Schwab said.

So when Philips volunteered to help map the entire military and Veteran caregiver experience in partnership with the foundation and the U.S. Department of Veterans Affairs, Schwab was ecstatic.

“Philips has been with us over the last four years, painting that picture of need, painting that picture of support, helping us forecast the long road ahead for military and Veteran families and for caregivers,” he said.

“Before we could create it, we had to identify the most common caregiving gaps,” said Vitor Rocha, Chief Market Leader of Philips North America. “So, our team talked to more than 500 Veterans and their families, advocacy groups, healthcare providers, and many others. We listened to courageous caregivers as they told their stories and pushed us to reimagine what is possible. The result is a roadmap that takes Veterans and caregivers from symptom to diagnosis, to treatment to home care, keeping the Caregiver at the center of the conversation.”

At the fourth national convening of the Elizabeth Dole Foundation, hosted at the Capital Hilton in Washington, the progress made since 2014 was palpable.

“Every caregiver story begins with an individual who raises their hand to serve our country,” founder Sen. Elizabeth Dole said to an audience of caregivers, Veterans, health providers and partners. “It is one of the greatest love stories ever told.”

Secretary of Veterans Affairs Robert Wilkie likewise pledged his commitment to caregivers.

“My mother became a caregiver when my father was seriously wounded,” he said. “Caring for our heroes is everyone’s business.”

Jacqui has been an Elizabeth Dole Foundation Dole Caregiver Fellow since 2017 and was involved in the development of the Caregiver Experience Map. Originally presented with a linear map, Jacqui’s input helped inform the circular prototype in use today, which she believed better represents her caregiver journey and that of many others.

Robert views the map as the opposite of the downward spiral Veterans often experience but don’t always escape. “(Instead), it’s an expanding circle,” he explained.

According to Schwab, one of the map’s primary functions is to help Veterans and their families prepare for what’s next — emotionally, psychologically, physically, socially and even financially.

“Caregivers and Veterans think a lot about what they need right now,” he said. “Our work with Philips has allowed them to think about tomorrow and the next day and a year down the road.”

Another key function of the map is to provide caregivers and Veterans’ families with effective resources at whatever point they’re at. Ideally, the map will act as a navigational tool from the start.

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The Departments of Defense and Veterans Affairs are gearing up for what will be the largest expansion of patrons to the military commissary system and exchanges in 65 years, making sure that shoppers will be able to get on base and find the shelves fully stocked.

Starting Jan. 1, Purple Heart recipients, former prisoners of war and all service-connected disabled Veterans, regardless of rating, as well as caregivers enrolled in the VA's Comprehensive Assistance for Family Caregivers program, will be able to shop at Defense Commissary Agency stores and military exchanges.

They also will have access to revenue-generating Morale, Recreation and Welfare amenities, such as golf courses, recreation areas, theaters, bowling alleys, campgrounds and lodging facilities that are operated by MWR.

Facilities such as fitness centers that receive funding from the Defense Department budget are not included.

At commissaries, however, there will be an added cost for new patrons who use a credit or debit card to pay for their groceries, in addition to the 5% surcharge commissary patrons already pay.

DoD officials told Military.com on Wednesday that an estimated 3.5 million new patrons will be eligible to shop. However, after analyzing store locations and their proximity to where Veterans live, they expect that slightly more than a quarter of those patrons, or 800,000 people, will take advantage of the benefit.

According to Barry Patrick, associate director of MWR and Resale Policy in the Office of the Under Secretary for Personnel and Readiness, the DoD expects Veterans in high-cost areas like Guam, Alaska, Hawaii and parts of California to take advantage of the benefit. Stores in states or cities with large populations of service-connected disabled Veterans, including Florida, California, parts of Texas and Washington, D.C., may also see an increase in customers.

"Through this data analytics tool that we've developed, we've been able to provide the services and the resale organizations information... to ensure that [they] can adjust," Patrick said. "We are working with distributors to ensure that the supply chain is adjusted accordingly, based on high-impact projections, and that the supply chain is also prepared for rapid, agile reaction to any unexpected situation."

In addition to ironing out the supply chain concerns, Pentagon officials also have been working to guarantee that the new patrons can get to the stores, which often are located on secure military installations, and will be able to make purchases.

The details have required a joint effort for much of the past year between the DoD and the Departments of Veterans Affairs, Homeland Security and Treasury. Homeland Security is involved because Coast Guard Exchanges are part of the deal, and Treasury plays a role, because it is responsible for ensuring that new patrons pay a fee for credit and debit card purchases at the commissaries.

Since most new patrons lack the credentials needed to get on military bases, installations will accept the Veteran Health Identification card, or VHID, from disabled and other eligible Veterans. For caregivers, the VA plans to issue a memo to eligible shoppers in the coming months, which will be used in conjunction with any picture identification that meets REAL ID Act security requirements, such as a compliant state driver's license or passport.

Justin Hall, director of the MWR and Resale Policy in the Office of the Under Secretary for Personnel and Readiness, said that, after Jan. 1, newly eligible patrons should go to the visitors' center at the base where they plan to do most of their shopping to register their credentials. Thereafter, they will be able to access the base in the same way as CAC and DoD ID card patrons.

According to Hall and Patrick, store computers and registers are being tweaked to scan VHID cards, and employees are being trained on identifying the new patrons.

The most significant difference mandated in the law that created the benefit, the fiscal 2019 National Defense Authorization Act, is that the new customers must pay a fee if they use a credit or debit card at the commissaries. By law, the stores, which receive funding from the Defense Department budget, are not allowed to cover the extra cost of the new users' card convenience fees.

The initial fee for commercial credit cards will be 1.9%; for debit cards, it will be 0.5%. Patrons can avoid the card fees by paying by cash or check, or by using the Military Star card, a credit card offered by the military resale system, which they will be eligible to apply for beginning Jan. 1.

The card fees will apply only to the new patrons.

The Defense Department is preparing a fact sheet that will contain information on how Veterans can get a VHID card if they don't already have one and how caregivers can obtain the memo they need to access the benefit.

MWR and Resale Policy officials said they also will launch an information campaign to alert service-connected disabled Veterans of this new benefit.

"Everybody I've talked to is excited," Hall said. "We're really hoping to get the word out so Veterans will learn about the opportunities."

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Military stores are gearing up for a potential 4 million extra people who will be eligible to shop at commissaries and exchanges, and to use certain morale, welfare and recreation facilities starting Jan. 1.

The new benefit was authorized by law for all Veterans with VA service-connected disability ratings; Purple Heart recipients; Veterans who are former prisoners of war; and primary family caregivers of eligible Veterans under the VA caregiver program.

It’s the largest patronage expansion in more than 60 years. Currently about 6 million total households are eligible for the benefit; this increases that number by 60 percent. Not all of the 4 million people are expected to use the benefit, because of distance and other factors, but officials are working to ensure no out-of-stock situations occur at stores in states with high populations of disabled Veterans and in states with higher cost of living.

Federal officials have determined that disabled Veterans will use their Veterans Health Identification Card (VHIC) to gain access to military installations, and to shop and use MWR facilities. The VHIC must display the Veteran’s eligibility status — Purple Heart recipient, former POW, or service-connected. Current Defense Department policy and the law have long allowed these benefits for Medal of Honor recipients and Veterans with 100 percent service-connected disability ratings.

Most installations’ front gate scanning systems now have the capability to scan the VHIC cards. However, these newly-eligible patrons should allow some extra time when they first visit the installation to stop at the visitor control center, where they must pass an on-the-spot background check. Depending on the type of installation, patrons may be enrolled for recurring access to allow them to proceed to the gate without stopping at the visitor control center on future visits. Spouses can’t buy anything, but they and other family members can accompany the Veteran into the store.

An estimated 37,000 Veterans qualify for the new benefit, but don’t qualify for the VHIC for various reasons. They won’t have access to the installations during the first phase of the rollout. A credentialing solution is being worked out for these Veterans, and will be rolled out at an unspecified later date.

Caregivers approved and designated as the primary family caregivers of eligible Veterans under the VA Program of Comprehensive Assistance for Family Caregivers will receive an eligibility letter from the VA’s Office of Community Care.

Newly eligible customers who shop in commissaries will pay a fee of 1.9 percent of their transaction if they pay with a commercial credit card, and 0.5 percent if they use a debit card. These fees won’t apply to those paying with a Military Star card, cash or check. By law, the expansion of customers can’t include extra costs associated with using credit cards in commissaries; the cost must be passed on to the customer. Commercial credit card companies charge transaction fees to retailer when customers use their credit cards. The fees only apply to newly eligible patrons. But as has been the practice for decades, all customers pay a 5 percent surcharge on transactions, required by law to pay for commissary construction, equipment and maintenance.

The benefit extends to revenue-generating MWR activities such as golf courses, bowling centers, movie theaters, RV campgrounds and recreational lodging.

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Autism Parenting Magazine has revealed more than a third of autism caregivers use an ABA therapy provider to support a child on the spectrum.

In a survey sent out by Autism Parenting Magazine (APM) to more than 160,000 email subscribers, over a third of responders confirmed they are using an Applied Behavior Analysis (ABA) therapy provider for their child.

In fact, a substantial 36.5% of caregivers reported that they use an ABA therapy provider and 93.7% of these individuals would recommend ABA to other autism caregivers.

A total of 72.4% of respondents identified themselves as autism parents, while the remaining participants were grandparents, full-time carers, teachers, therapists, doctors, or individuals on the spectrum.

How does ABA therapy support children with autism?

ABA therapy can support children on the autism spectrum in many ways, including the development of social skills, life skills, stronger communication, and adapting challenging behaviors.

From the ABA users surveyed by APM, 79.2% said they have seen an improvement in their child’s meltdowns, while 89.9% have seen improvements in their child’s communication.

“Within the autism community there are mixed feelings about ABA. But, research has shown time and again that ABA is the most effective treatment for autism for reducing problematic behaviors and increasing adaptive skills. When correctly implemented, ABA can be life changing, not just for your child, but for your entire family,” says behavior analyst Angelina Macdonald, MS, BCBA, LMFT.

“ABA can be used as an intervention strategy not only to understand certain behavior better but also to change or modify behaviors through scientifically-based principles,” adds Carol Tatom RBT, an autism mom and behavior technician. “The basic principles of ABA therapy are designed to help alter challenging behaviors over time into more functional and ‘appropriate’ behaviors.”

Why parents are choosing ABA therapy

A total of 71.7% of ABA users surveyed stated they were recommended ABA by their doctor. The main reason for choosing ABA for those surveyed was to target challenging behaviors including meltdowns, as well as to teach socially acceptable behaviors while building life skills.

“The main goal of most autism parents is to teach self sufficiency and independent living. Life skills become so important and, if you’re doing ABA, it has to follow you home,” comments autism mom Katrina Walsh, BHR.

ABA therapy during the COVID-19 pandemic

APM’s survey revealed a huge surge in parents signing up for ABA therapy since the COVID-19 pandemic began. A total of 31.6% of ABA users stated they started ABA sessions during the pandemic, while a significant 49.2% found they have needed more ABA sessions since the pandemic began.

Possible reasons for this might include increased anxiety among autistic children during these turbulent times as well as challenges around changing routines, lack of structure, and being confined to the home.

Age of children and level of autism support needs

ABA is generally selected as an early intervention therapy, so it was not surprising that 68.8% of ABA users surveyed by APM said their child started the therapy under the age of five years old.

The majority of the children undergoing ABA therapy required “substantial support” with their daily living. A total of 42.9% of respondents identified their child as “requires substantial support”, while 39.3% said their child “requires support” and 17.9% answered “very substantial support”. 61.74% of all survey respondents were from the USA.

Advice for parents considering ABA for their children

There is much controversy surrounding ABA therapy, with some members of the autism community disagreeing with the concept of adapting behaviors. However, a whopping 93.9% of survey respondents said they believe their child has benefited positively from ABA.

A total of 87.9% also said their child enjoys their ABA sessions and a huge 94.2% said they believe their ABA provider has their child’s best interests in mind.

Some top tips to bear in mind when considering ABA and choosing a reputable provider include:

• Find out who is overseeing the treatment and their qualifications
• Ensure the provider is using an individualized approach
• Find out how challenging behavior is addressed
• Ensure that everyone involved is well trained and informed

“Yes, some studies show early intervention is beneficial, but my personal advice would be to slow down before jumping to the first service provider you find and take a look at your child. What do you truly feel would be best for him/her? Would your child cope in a strict behavioral setting, or does he/she require a more fluent and easygoing therapist?” says Karla Pretorius, M. Psych, a Research Psychologist in the field of autism.

“As a parent, I thought choosing an ABA organization was similar to choosing a pediatrician or a dentist: they are board-certified, so they must know what they are doing. Surprisingly, because the field of ABA is new (unlike the general medical profession, which has been around for more than 25,000 years), just because someone is board certified in ABA does not necessarily mean he/she is a seasoned clinician, adds Carla Gross, MA, LPEC, Development Director of the Behavioral Health Center of Excellence which accredits ABA providers.

“At the end of the day, organizations that have committed to continuous improvement and quality standards are the ones that have always stood out to me as a mom.”

Summing-up

While ABA therapy is a controversial topic, it seems it is growing in popularity and – as with any therapy solution – the quality and benefits depend on the provider and each individual child. Overall, the autism caregivers involved in the survey spoke positively about ABA therapy and 86.7% said it has helped them to better understand their child’s needs.

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Tens of thousands of caregivers providing critical medical support to disabled Veterans will be eligible to receive coronavirus vaccine doses soon under a new policy announced by the Department of Veterans Affairs this week.

The move comes after a coalition of Veterans groups lobbied for the caregivers to be pushed to the top of the vaccine list, arguing that they deserved to be included in the first wave of medical professionals being protected against the deadly illness.

In response, Dr. Richard Stone, executive in charge of the Veterans Health Administration, released a memo this week asserting that individuals registered with the department’s Program of Comprehensive Assistance for Family Caregivers can be given the vaccine “in a coordinated manner with the Veterans for whom they provide care.”

Specifics on an exact timeline for vaccinations was not released. The memo states that decisions will be made “in balance with site-specific resources, needs, vaccine availability, hesitancy to accept the vaccine, and status of the pandemic locally.

In an interview with Military Times, Stone said that he is shifting many of those vaccination decisions to local officials, in an effort to provide coverage to more individuals.

“We need to leave it up to people at the besides, to make sure they are making the best decisions for Veterans,” he said. “When someone brings a Veteran in to give them the vaccine, they can easily identify what the other needs are.”

For caregivers like Jennie Beller, the news is welcome relief.

Her husband, Chuck, is a 68-year-old disabled Vietnam Veteran who is expected to receive the coronavirus vaccine in coming weeks. Beller said health officials were planning to travel to their Indianapolis home to administer the dose, but were only authorized to bring medicine for him, not her.

“I’m his only caregiver. If I get sick, there is no one to give him help,” said Beller, 58.

“This is an enormous relief to us. It was going to be a nightmare trying to figure out the logistics of us getting separate vaccines, potentially months apart from each other. Now we don’t have to worry about that.”

About 20,000 Veterans are registered in the VA caregivers program, which provides monthly stipends and other support to individuals providing regular medical assistance to infirm Veterans.

Most of that group are family members of post-9/11 Veterans. The caregiver assistance program expanded last fall to Veterans who served before May 1975. Beller was among the first to be included in that new group. The program is set to expand to all Veterans in late 2022.

Last week, a coalition of Veterans groups including The Independence Fund, Military Order of the Purple Heart, and the Non Commissioned Officers Association sent a letter to Federal Emergency Management Agency officials asking them to authorize VA to administer the caregiver vaccines, under its role as the lead coordinator of federal response to the pandemic.

But VA officials in this week’s memo argue they have the ability to move without that specific bureaucratic step, saying the caregiver program authorities allow them to provide such services in an effort to better protect and serve Veterans.

“The laws and regulations on this issue are very complex,” said Bob Carey, executive vice president for advocacy and strategy at The Independence Fund. “It’s not easy to navigate the various authorities and processes available to make this happen. But the VHA team leading this vaccine effort were dogged in finding a solution.”

Stone said as of Wednesday, VA officials had administered the first dose of the two-part vaccine to more than 332,000 department health care employees and Veterans at high-risk of contracting coronavirus. Another 45,000 individuals have already received their second dose.

Vaccines have been distributed to more 195 department facilities, but health officials have warned that it could be months before they can administer the more than 7 million vaccines they expect to be requested by Veterans and staff.

More than 180,000 patients connected to the Veterans Health System have contracted coronavirus since the start of the pandemic, and more than 7,500 have died from complications related to the illness.

Beller said she hopes to get doses for her and her husband as soon as possible.

“We’ve been doing everything we can since this started,” she said. “And when he gets the call to go ahead, we’ll get (the vaccine) right away.”

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Thousands of Veterans caregivers could see their Veterans Affairs stipends reduced or taken away completely under a series of case reviews planned over the next year to ensure long-time participants still qualify for the benefit.

Veterans Affairs officials said that no families currently in the Program of Comprehensive Assistance for Family Caregivers will see reductions in stipends before fall of next year, and families being removed from the program won’t have the financial support cut off until early 2023.

But the move still means the looming loss of thousands of dollars a month for some families of Veterans with serious, lingering service injuries.

About 33,000 individuals are currently enrolled in the program, which provides support services and monthly stipends to caregivers of Veterans unable to perform basic self-care activities.

Program Executive Director Colleen Richardson said the reviews will cover about 19,800 “legacy” participants, all of whom entered the program before October 2020. Before then, only Veterans who left the ranks after September 2001 were eligible to apply for the program.

Officials expect about one-third of that group — around 6,700 families — to be completely dropped from the program after the review, based on preliminary work. It’s unclear how many more could see reductions in the amount of financial support they receive each month.

In addition, some Veterans could see increases in the amount of payouts they receive, if reviews find they are eligible for more support.

Department officials hope to complete the reviews in the next six months, but Richardson said no stipend reductions will take place before October 2022, to ensure that families are given time to deal with the financial impact of the moves.

Caregivers being dropped from the program will get an additional five months of payments as they transition out, Richardson said.

“And even though they may not qualify for the stipend, they will still qualify for services within the caregiver support program” such as counseling and training offerings, she said.

The reviews will include medical exams and in-home visits (or virtual, if pandemic concerns linger) to determine Veterans’ independence and ongoing assistance needs. Veterans involved will not need to reapply; instead, program officials will contact them about the reassessments.

About 107,000 caregivers applied to the program in the past year, mostly connected to Veterans who served during the Vietnam War or in earlier eras. That group wasn’t eligible for the program until last fall. The approximately 13,000 individuals approved from that group in the last year will not be part of the new reviews.

Richardson said the new move also is not expected to disrupt plans scheduled for next fall to expand the caregiver program to Veterans of any era.

Stipend calculations are based on the severity of Veterans’ injuries and the cost of living in the area where they live.

For example, a caregiver tending to a severely injured Veteran living in the Washington, D.C. area could receive up to $3,100 a month in financial support. Individuals in a less costly area with less severe medical complications could see half that amount.

The new reviews are separate from potential changes linked to a U.S. Court of Appeals for Veterans Claims ruling earlier this year requiring a new appeal process for individuals rejected for the caregiver stipend program. Richardson said officials expect to have additional announcements on that issue in coming days.

More information on the reviews is available on the VA web site.

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As a military spouse, you’re qualified, educated and ready to serve. You have a unique perspective and understanding of what it means to care for our nation’s heroes. Here at VA, we value this experience.

We also know you bring so much more to the table.

That’s why we’ve partnered with the U.S. Department of Defense (DOD) Military Spouse Employment Partnership (MSEP) program. The career program connects military spouses with more than 390 affiliated employers who have committed to recruit, hire, promote and retain military spouses in jobs everywhere.

“VA is thrilled to help DOD and military installations engage military spouses in conversations about career opportunities caring for our nation’s Veterans,” said Tracey Therit, Chief Human Capital Officer at the Office of Human Resources and Administration/Operations, Security and Preparedness. “We are using every method — communications, job feeds, social networking and more — to provide information on the federal hiring process and links to real opportunities at VA.”

Finding opportunities to grow

There are over 600,000 active duty military spouses worldwide. Of those actively seeking employment, 30% are unemployed and 56% underemployed.

How are MSEP and VA making sure you get the chance to apply for a meaningful and rewarding career? Quite a bit, in fact.

On USAJobs, we tag VA jobs ideal for military spouses. We highlight key information — remote work opportunities, flexible work schedules, child care and health benefits — on our job announcements.

For positions covered under Title 5 hiring authority, we use noncompetitive procedures approved by the Office of Personnel Management. That means when you apply to become a VA accountant, police officer or human resource specialist and meet the minimum qualifications, you’re hired.

We also work with DoD to identify spouses with health care experience or training as a physician, nurse, social worker or occupational therapist. These VHA-administered positions do not require application through USAJobs.

Choose VA today

A career with VA is meaningful and mission-driven — and our total rewards benefits package consistently edges out those offered by the private sector. Keep an eye on this space for more on how military spouses can benefit from choosing a VA career.

• SEARCH for open positions using “military spouses” as a keyword.
• WATCH Tracey Therit discuss VA’s commitment to hiring military spouses.
• EXPLORE the benefits of a VA career.
• REACH a recruiter at This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it..

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As the spouse or dependent child of a Veteran or service member, you may qualify for certain benefits, like health care, life insurance, or money to help pay for school or training. As the survivor of a Veteran or service member, you may qualify for added benefits, including help with burial costs and survivor compensation. If you’re caring for a Veteran with disabilities, you may also qualify for support to help you better care for the Veteran—and for yourself. Find out which benefits you may qualify for and how to access them.

Benefits for spouses, dependents, and survivors

Health care

Find out if you may qualify for health care through our CHAMPVA program, the Department of Defense's TRICARE program, or one of our programs related to a Veteran's service-connected disability. If you already have health care through VA, learn how to manage your health and benefits.

For spouse, dependent child, surviving spouse, surviving child

Education and training

Find out if you may be eligible for help paying for school or job training through our Survivors' and Dependents' Education Assistance Program (also called Chapter 35) or the Marine Gunnery Sergeant John David Fry Scholarship. And learn about how a Veteran may transfer their unused Post-9/11 GI Bill benefits to you.

For spouse, dependent child, surviving spouse, surviving child

Home loan programs or financial counseling

Apply for a Certificate of Eligibility (COE) for VA home loan programs to buy, build, repair, or refinance a home. Or, if you're having trouble making mortgage payments on a VA-backed loan, get help to avoid foreclosure and keep your house.

For surviving spouse

Life insurance options, claims, and beneficiary assistance

Learn how to apply for Family Servicemembers' Group Life Insurance (FSGLI) coverage, explore other coverage options, and manage an existing policy. If you're the beneficiary of a Veteran's or service member's policy, find out how to get free financial advice and will preparation services.

For spouse, dependent child, surviving spouse, surviving child

Pre-need eligibility determination for burial in a VA national cemetery

Apply in advance for eligiblity to be buried in a VA national cemetery. This can help you plan ahead to make the burial process easier for your family in their time of need.

For spouse, dependent child, surviving spouse, surviving child

Burial benefits and memorial items

Get step-by-step guidance on how to plan a burial in a VA national cemetery, or in a state or tribal government Veterans cemetery. You can also apply for help paying for burial costs, request memorial items, and learn about bereavement (grief) counseling and transition support.

For surviving spouse, surviving child, surviving parent

Survivors Pension

If you're the surviving spouse or child of a Veteran with wartime service, find out if you're eligible for monthly pension benefits.

For surviving spouse, surviving child

Compensation for surviving spouse and dependents (DIC)

If you’re the surviving spouse, child, or parent of a service member who died in the line of duty, or the survivor of a Veteran who died from a service-related injury or illness, find out how to apply for this tax-free monetary benefit.

For surviving spouse, surviving child, surviving parent

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During National Family Caregivers Month this November, the U.S. Department of Veterans Affairs (VA) will honor the caregivers of Veterans for their invaluable health care, acknowledging the critical role they play in caring for Veterans every day — and even more so during the COVID-19 pandemic.

VA medical centers nationwide will host virtual events to raise awareness of the Caregiver Support Program’s recent expansion and to highlight the contributions of Veterans’ caregivers.

“Caregivers are important members of a Veteran’s health care team and the pandemic has amplified their significance,” said VA Secretary Robert Wilkie. “We recognize their ongoing commitment to the well-being of Veterans and the roles they play in Veterans’ lives daily. Providing a wide range of resources to help them care for Veterans and themselves is paramount.”

As part of VA’s historic change to the Caregiver Support Program, the department began the first phase of expanding its Program of Comprehensive Assistance for Family Caregivers (PCAFC), Oct. 1, which extended the program to eligible Veterans who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975. The second phase, effective Oct. 1, 2022, will expand the program to eligible Veterans who incurred or aggravated a serious injury in the line of duty between May 7, 1975 and Sept. 11, 2001. PCAFC offers assistance to Family Caregivers of eligible Veterans, including education and training, respite care, a monthly stipend and more.

VA also offers caregivers of Veterans services under the Program of General Caregiver Support Services (PGCSS). PGCSS is available to all caregivers who provide personal care services to covered Veterans enrolled in VA health care. PGCSS participants have access to education and training, respite care, and additional services such as VA’s Peer Support Mentoring.

To learn about local events or more about VA’s Caregiver Support Program, contact your local facility’s VA Caregiver Support Coordinator or call the Caregiver Support Line 8 a.m.-10 p.m. EST Monday-Friday and 8 a.m.-5 p.m. EST Saturdays.

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Veterans Affairs officials are overhauling their application process for caregiver benefits while simultaneously fighting a court ruling that would force them to allow a legal review for individuals rejected for the program.

The move follows an order last month from a panel of U.S. Court of Appeals for Veterans Claims judges, which ruled that families rejected by the Program of Comprehensive Assistance for Family Caregivers should have an opportunity to appeal those decisions to the Board of Veterans’ Appeals, which handles other VA benefits disputes.

But VA officials have opposed that idea, arguing instead that keeping program decisions within the clinical side of department operations will produce better health care options for Veterans and less complexity for families.

“We believe that participation in this program is part of a Veteran’s overall medical care plan,” said Meg Kabat, senior advisor on families, caregivers and survivors at VA. “These clinical and medical decisions being thrown into the litigation process is not what is best for Veterans.”

On Monday, VA asked the full Veterans claims court to revisit the April decision. At the center of the case are concerns over how applications to the caregiver program are handled. For Veterans who need significant home care from a spouse or family member, the program awards up to $2,300 a month in stipends and access to additional support services.

About 25,000 Veterans are participating in the program today, and another 27,000 applications are pending. Currently, leaders from individual VA medical centers review applications and make decisions on who receives the benefit.

That has led to complaints about inconsistency and a lack of transparency with the application process from a number of Veterans advocates, and formed much of the basis of the recent lawsuit.

Kabat said those applications will now go to clinical teams at each of the department’s 18 Veterans Integrated Service Networks. More than 200 new medical professionals are being hired for the work.

Veterans who are rejected for the program by the new review panels will be able to appeal to a different VISN twice if they believe the decision was made in error. VA officials said the new process will allow families and outside advocates to better understand the reasons for the decisions, and ensure that similar applications across the country are handled in a similar way.

But the new process will likely do little for families rejected in the past who could be in line for a substantial financial payout under the appeals court’s April order.

In that case, Jeremy Beaudette, a Marine Corps Veteran who left legally blind and suffering from traumatic brain injury after multiple combat tours in Iraq and Afghanistan, was rated as 100 percent disabled by VA officials because of his wounds.

But when his wife, Maya, applied for benefits through VA’s caregiver program she was rejected. Multiple appeals to department officials were also denied.

Thanks to their court victory, the couple can appeal the decision to the Board of Veterans’ Appeals, which could award back benefits as well as new eligibility for the caregiver program.

Nothing in the new application process unveiled by VA Monday would award back pay to Veterans previously rejected for the program. In a statement, Amanda Pertusati, supervising staff attorney at Public Counsel (which brought the lawsuit against the department), said officials are still reviewing the changes.

“We look forward to implementing the courts order to ensure that all caregiver program claimants have the ability to seek appellate review, as well as to obtain the benefits that they are entitled to,” she said. “It is unfortunate that the parties and the court will now have to be distracted by VA’s attacks on the court’s decision, rather than focusing all efforts to implement it.”

The court ordered VA to develop an implementation plan for the retroactive appeals by June 3. VA officials said they will follow that order, even as they fight the lawsuit.

Meanwhile, outside advocates say they are watching both the legal fight and program reforms closely.

“We commend VA for its commitment to comply with the lower court’s decision and we strongly encourage them to continue collaborating closely with the [Veterans] community on communications, planning, and strategy moving forward,” said Steve Schwab, CEO of the Elizabeth Dole Foundation

“We await the full court review of this case, but EDF is committed to working with the VA on a more equitable and transparent appeals process that provides all caregivers with a chance to access the benefits they have earned and deserve.”

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The U.S. Department of Veterans Affairs (VA) announced today implementation of a new information technology (IT) system marking the official launch of the first phase of expansion of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) to caregivers of eligible Veterans of earlier eras.

The Caregiver Records Management Application (CARMA) automates manual processes and integrates with other VA systems, resulting in increased efficiencies and effectiveness for VA staff.

The expansion rolls out in two phases. Effective Oct. 1, the first phase includes eligible Veterans who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975. Effective Oct. 1, 2022, the second phase will include eligible Veterans who incurred or aggravated a serious injury in the line of duty between May 7, 1975 and Sept. 11, 2001.

Through CARMA, with a click of a button, an electronic health record will be created for a family caregiver where Caregiver Support Coordinators will document their clinical interactions. CARMA will also help guide consistency by systematically adjusting VA’s stipend payment calculations, as appropriate, and alerting VA users when annual reassessments of PCAFC participants are due, among other key functionalities. In addition, this program expansion also includes a new digital version of the application which allows individuals to apply for the PCAFC online.

“Caregivers provide stability and security to our most vulnerable Veterans, allowing them to stay in their homes with their loved ones for as long as possible,” said VA Secretary Robert Wilkie. “Today begins the first phase of expansion of the Program of Comprehensive Assistance for Family Caregivers. Through this expansion, VA is able to give more family caregivers access to essential resources so we can support them as they care for Veterans of earlier eras.”

Since publishing the final regulation July 31, to improve and expand PCAFC — VA also expedited hiring key staff who bring the clinical qualifications and organizational skill sets to ensure consistent eligibility decision making across the enterprise, support program needs and provide strong infrastructure for consistent and standardized application processing and adjudication.

This past year, the Caregiver Support Program expanded to approximately 1,100 staff and will grow to approximately 1,800 staff within the next six months. These changes ensure Veterans and caregivers receive timely, accurate assessments and eligibility determinations, as well as an improved customer experience.

Previously, only available for eligible Veterans who incurred or aggravated a serious injury in the line of duty on or after Sept. 11, 2001, PCAFC provides education, support, a monthly stipend, health care coverage and certain beneficiary travel to qualifying family caregivers of eligible Veterans.

VA’s Caregiver Support Program offers a wide variety of support services for caregivers of Veterans. Partnerships continue to be created or enhanced to broaden services and supports for caregivers. Learn more by visiting the Caregiver Support Program website or by calling the Caregiver Support Line at 855-260-3274 for more information.

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The U.S. Department of Veterans Affairs (VA) will publish a proposed rule in the Federal Register March 6 that would improve and standardize VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) and ensure the program regulations reflect changes required by the VA MISSION Act of 2018.

A component of the Caregiver Support Program, the PCAFC was established in 2011 to provide additional benefits including a monthly stipend for qualifying family caregivers of eligible Veterans who were seriously injured in the line of duty on or after Sept. 11, 2001.

In the proposed rule, VA seeks to standardize eligibility by expanding the definition of serious injury to include any service-connected disability — regardless of whether it resulted from an injury, illness or disease — defining what it means to be in need of personal care services, and ensuring that the eligibility criteria capture the personal care service needs of Veterans and Servicemembers with cognitive or neurological impairment or mental health conditions, among other things.

Additionally, VA is proposing changes to the stipend payment methodology, definitions for financial planning and legal services and procedures for revocation and discharge, to include advance notice requirements aimed at improving communication between VA and PFAFC participants.

“We owe a tremendous debt of gratitude to caregivers who work tirelessly to provide critical support for our nation’s Veterans,” said VA Secretary Robert Wilkie. “This proposed regulation would improve the assistance we provide to help ensure our most vulnerable Veterans can stay in their homes with their loved ones for as long as possible.”

VA’s Caregiver Support Program is the first of its kind and addresses the complexity and expense of keeping loved ones out of institutions and at home with their families who provide personalized care. The program offers unparalleled support services including training, peer mentoring, respite care, a telephone support line and self-care courses for caregivers of all Veterans enrolled in VA health care who need personal care services.

The regulations are part of a broad effort to strengthen PCAFC in advance of a planned expansion under the MISSION Act which expanded eligibility for PCAFC to eligible Veterans from all eras, beginning with those who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975. Two years after the first phase of program expansion, PCAFC will include eligible Veterans who were seriously injured in the line of duty between May 7, 1975 and Sept. 11, 2001. Prior to expanding, VA must fully implement an information technology (IT) system required by the MISSION Act.

In October 2019 VA launched a commercial off-the-shelf IT system and expects to complete deployment in late summer or early fall of 2020. The department also standardized operating procedures for the Caregiver Support Program, provided new training for staff and caregivers and is boosting operational capacity through hiring of additional staff. These changes are necessary as VA prepares to expand PCAFC.

Learn more about support services available for caregivers of Veterans or call the Caregiver Support Line at 1-855-260-3274.

The proposed rule will be open for public comment in the Federal Register for 60 days.

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The U.S. Department of Veterans Affairs in partnership with the Elizabeth Dole Foundation (EDF) today announced the launch of a new foundation program granting family caregivers access to no-cost, short-term aid to help those caring for wounded, ill or injured Veterans or service members in their homes during the coronavirus pandemic.

Under the Respite Relief for Military and Veteran Caregivers program, caregivers of Veterans can apply to receive approximately 24-hours of respite care from a CareLinx professional to help with bathing, companionship, cooking, exercising, grooming, light housekeeping, medical and medication reminders, mobility assistance, transportation and other activities.

“Caregivers charged with caring for our nation’s Veterans face new challenges during the COVID-19 pandemic,” said VA Secretary Robert Wilkie. “They have become increasingly isolated and are hindered from getting reliable, outside help. This program provides caregivers compassionate and needed relief during this stressful time.”

Respite Relief for Military and Veteran Caregivers will initially be available in select regions of California, Florida and Texas. The EDF will work to expand the program to other regions of the country later this year. AARP will also be supporting the effort by sharing information about the program with their members in the selected states.

Applicants to the Respite Relief for Military and Veteran Caregivers program will be selected and awarded by the Elizabeth Dole Foundation. Apply at hidden heroes.

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A place of help, hope and healing

Through a partnership between VA and CaringBridge, Veterans and their caregivers can use free CaringBridge social sites as a place of help, hope and healing.

CaringBridge is a nonprofit social network dedicated to helping family and friends communicate with and support loved ones during a health journey with a free, personal and protected website. It takes only a few minutes to create a site and share an update on your health and then invite your family, friends and peers to your site to receive strength and encouragement from your community.

There are many stories of CaringBridge families who receive the support of their loved ones to emotionally heal during difficult times. Army Veteran Jeff Edwards is one of these stories, who used his community to keep going after his injury.

After Spinal-Cord Injury, ‘Protect and Serve’ Takes New Shape

Jeff Edwards of Herman, Minn., fell from roofs and crashed dirt bikes as a kid, parachuted into dangerous places with the U.S. Army’s 82nd Airborne Division, and faced potential harm for 13 years as a sheriff’s deputy and SWAT-team marksman. Breaking his neck in shallow water, while on vacation in Mexico in 2015, was not something Jeff had ever imagined.

“It was just a freak accident,” he said. “I got rolled by a wave and hit the crown of my head on the bottom of the ocean… instantly paralyzed.” Jeff said he remembers thinking, “All the dangerous and dumb things I have done in my life, and a wave takes me out?”

After a medical evacuation—securing an air ambulance that required up-front payment of $30,000 became longtime girlfriend Dani Murdoff’s first act as a caregiver—Jeff had surgery at Abbott Northwestern Hospital in Minneapolis to stabilize his spinal cord. And then he set his first goal: going home.

Using CaringBridge

During his health journey, Jeff and Dani built a CaringBridge site to update family and friends and to request support. CaringBridge allow families to easily reach out in times of medical need. Jeff and his family let their community know their needs through journal posts and directing them to the Ways to Help section of their CaringBridge site.

“I hated being in the hospital,” Jeff said. “They said I would have to be there for at least three months, and then I would be in [physical] rehab for six months.” But after just one month, he transferred to the Spinal Cord Injury & Disorder Center at the Minneapolis VA Health Care System.

Doctors at the VA, where Jeff was eligible for treatment as a Catastrophically Disabled Veteran, also thought it would take six months for him to master a wheelchair, bathe, dress, cook and learn to drive with hand-controls. But in three months and 10 days, Jeff “checked all the boxes” of self-sufficiency.

He then went home to figure out his next steps with his family, friends and law enforcement community that had rallied around him.

Making the transition home and moving on

While Jeff was in the hospital, Dani put up for sale the two-story house they had been restoring and put into motion plans for building a place with an open floor plan and no stairs. Next on the to-do list was a new line of work. “Obviously, I couldn’t be a law enforcement officer,” Jeff said. “You have to be able to chase the bad guys.”

Through the VA and Paralyzed Veterans of America, Jeff landed a work-at-home job with a computer-storage company based in New York. He wanted to quit on Day 2. “It was completely different from what I was used to, and way out of my knowledge base,” he said. “But I’m not much of a quitter, so I figured I would give it a week… and within the first month I started catching on.”

Although “not a quitter” sums up so much, Jeff said he still thinks about the day his life changed.

“Every day there are ‘what-ifs,’” he said. “I think, ‘What if I had just hung out at the pool that day? Or gone across the street to shop? Or had not even gone on vacation?’ How different my life would be.”

While he said he feels entitled to those thoughts, Jeff won’t let them take over. He also refuses to be consumed by anger. “So many guys with injuries like this are angry with the world,” Jeff said. “But I look at it like, ‘This was my fault… something I did to myself.’ Granted, nature had a little hand in it, but I made the decisions that led up to what happened.”

Advice on healing and saying yes to help

What remains difficult is being on the receiving end of help. “Learning how to say, ‘yes’ to help was very, very hard. And it still is,” Jeff said. “But I am getting a little better.”

And life offers so many opportunities to practice. Jeff is handy—his workshop gives him away—so talking son Jake through repair of things out of Jeff’s reach offers an exercise in bonding.

He also enjoys hunting and fishing, which remain possible thanks to an all-terrain wheelchair. Being outdoors and doing activities he loves is good for Jeff’s soul, although having to depend on Dani or daughter Briona to load the track-chair onto its trailer is yet another reminder of how life has changed. Reconciling the before-and-after like this is at the core of Jeff’s healing process.

For Jeff, healing is a mix physical and mental. And while he does not pretend to have all the answers, he has this advice for others: “For me to heal, I had to push myself. Maybe you’re not going to be 100%, but you’re going to be at 100% of what you are capable of at a time. The stronger you can stay mentally, the better off you will be as a person. Try to do the best you can, with what you have. That’s what healing means to me.”

To learn more about CaringBridge, visit www.caringbridge.org/military.

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