Ahead of VA MISSION Act Expansion, Caregiver Program Requires Attention

According to a recent analysis from the Department of Veteran Affairs (VA) Office of Inspector General (OIG), the VA has not adequately monitored its Caregiver Assistance Program, which has resulted in patient care access limitations and insufficient program discharge processes. 

The Caregiver Assistance Program is part of the VA’s Caregiver Support Program that provides a monthly stipend to the caregivers of qualifying veterans. 

“The Veterans Health Administration (VHA) reported spending over $464 million to run the Caregiver Support Program in FY 2017,” the report said. “This was a dramatic increase of about 321% from the approximately $110 million VHA spent during the program’s first full year of operations in FY 2012. The majority of the increase is the result of a significant enrollment increase in the Program of Comprehensive Assistance for Family Caregivers (Family Caregiver Program).”

According to the OIG, veterans often qualify for the program after experiencing a serious injury in the line of duty on or after September 11, 2001. These eligible veterans rely on personal care services for supervision and protection or to help with daily activities. Further, the Caregiver Assistance Program relies on caregiver support coordinators who work across 140 VA medical facilities. These caregivers in charge of monitoring the well-being of eligible veterans at least once every 90 days. The OIG noted that these check-ins are essential for the discharge process, as well. The caregivers can determine whether veterans are discharged because they no longer require caregiver services or because caregivers are not complying with program guidelines.

Despite program execution, Congressional and media reports surfaced claiming veterans were being inappropriately and unnecessarily discharged from the program. In response, the OIG conducted an audit between June 2017 and 2018 that compared veterans both enrolled in and discharged from the program and reviewed monitoring habits and enrollment or discharge processes. Based on the findings, the OIG concluded that the program often resulted in insufficient patient care access or delays in care. Further, the OIG found that caregivers were not determining veteran eligibility within an allotted 45-day period for roughly 65% of veterans who were approved for the program. 

“The OIG found that clinicians and [caregiver support coordinators] either did not adequately document how much veterans’ health conditions changed, or failed to routinely monitor these veterans and their caregivers prior to the clinical reassessment that led to their program discharge,” OIG explained.

According to the OIG, their findings have implications for future policies, including the VA MISSION Act, and it is important that the VA improve its veteran eligibility process for the Caregiver Support Program. 

Congress passed legislation earlier this year that expands the family caregiver program as part of the MISSION Act and allows caregivers to help all veterans—not just those serving after September 11, 2001. 

“The OIG recommended the VHA Executive in Charge establish policies and implement procedures to improve Family Caregiver Program operations,” the report noted.—Julie Gould