What is P.L. 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010?

1. Debra A. Volkmer, LCSWCaregiver Support Coordinator – VISN 6 LeadTara Zollicoffer, LCSWCaregiver Support Coordinator

2. What is P.L. 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010? • Requires VA to establish a program of comprehensive assistance for family caregivers. • Requires VA to establish a program of general caregiver support services. • Authorizes VA to provide medical care to certain primary family caregivers through CHAMPVA (under 38 United States Code (U.S.C.) § 1781 (section 102). • Increased respite services for caregivers, including 24 hour care • Provide counseling and mental health services for caregivers (under 38 United States Code (U.S.C.) § 1782 (section 103). • Authorize VA to provide the expenses of travel (lodging and subsistence) for family caregivers during travel to and from a VA facility for the Veteran’s medical exam, treatment or care.

3. VAMC Caregiver Support Coordinator • Coordinate the VA Medical Center’s Caregiver Support Program and serve as clinical expert on caregiver issues and resources. • Assist family caregivers with the psychosocial and emotional stressors of caring for an ill, injured, or disabled Veteran through contact and triage/referral to Veterans team. • Ensure that caregiver awareness is integrated into all programs. • Provide social services resources linking the caregiver to VA health care and community services. • Use clinical skills to assess for caregiver burden provide supportive counseling, and plan interventions to support Veterans and their caregivers. • Responds to referrals received from the National Caregiver Support Line. • Develop and chair a Caregiver Advisory Board (CAB) • Coordinate events and programs for National Family Caregivers month. • Participate in monthly caregiver support and caregiver coaching calls.

4. P.L. 111-163 Benefits Sections 101-104 General Caregiver Services • Education and training • Counseling • Support Groups • Lodging if Veteran present • Fisher Houses • Respite Care • Home Based Primary Care • Telehealth • Non-Institutional Care • Caregiver Healthy Living Center MyHealtheVET • Caregiver Information on VA Health Web site • Triage/Referral to internal/external resources New Benefits – Post 9/11 Primary Caregiver • Caregiver stipend -Formalized training program -Validation of competencies -Ongoing monitoring • Health care coverage • Mental health services • Travel, lodging, subsistence and respite for training and for hospital stays Additional Family Caregivers • Formalized training • Travel, lodging, subsistence and respite for training and for hospital stays

5. Post 911/Veteran Eligibility • A Veteran or Servicemember undergoing medical discharge from the Armed Forces: who has a serious injury incurred or aggravated in the line of duty in the active military, naval, or air service on or after 9/11/2001; and is in need of personal care services because of an inability to perform one or more ADLS; a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury; or such matters as VA considers appropriate. (Caregiver may receive a monthly stipend and additional benefits, once the plan is fully implemented and if Veteran is approved) • The stipend for each primary caregiver will be based on a 3 tier system recognizing the complexity of care required by the Veteran and provided by the caregiver • 3,000 Veterans estimated to be eligible, with the possibility of 30-50 applications for this VA Medical Center. However, the exact number is very difficult to predict at this time.

6. Model of Categories of Caregivers in P.L. 111-163 (New and expanded benefits and services for general, family and primary family caregivers.)

7. Program of Comprehensive Assistance for Family Caregivers Process

8. CSC CG’s - Currently • Approved Family CG: 57 • In – Process CG: 8 • Approved General CG: 72

9. Salisbury CSC-Referrals

10. National VA Caregiver Support Line Licensed clinical social workers are available to answer questions, listen to concerns and directly link callers to the Caregiver Support Coordinator at their local VA Medical Center.

11. www.va.caregiver.gov

12. Challenges/Opportunities Challenges • Identification and assessment of Veterans to determine eligibility • Increased respite services , including 24 hour in home care • Mental Health Services for caregivers (non-prescriptive care) • Travel, Lodging and Per Diem-VA authorized to provide the expenses of travel, lodging and subsistence for the duration of medical exams, treatment or episodes of care (eligible veteran caregivers). • Authorize VA to provide the expenses of travel (lodging and subsistence) for family caregivers during travel to and from a VA facility for the Veteran’s medical exam, treatment or care. • Collateral Documentation and note titles entered into CPRS. • National Tracking Device (CAT) • Upcoming Performance Measures • 2 day turn around for all referrals and 10 day turn around for in-home visits. Opportunities • Close Collaboration with the OEF/OIF/OND team for referrals/team meetings/ Council meetings. • RN has been hired and is conducting HV – need to get her functional Statement complete so she will be considered a mental health provider. • Home Visits (win/win HBPC /RN – CM for CSC - increase numbers and the home visit gets completed) • Increased notice and identified needs of Primary caregivers (ineligible for stipend) • Revenue enhancement / keeping veterans out of the hospital/nursing home setting/ED, etc.

13. Moving Forward • Second CSC on board. • Presentations and Education planned for external/internal stakeholders. • Steering committee planned for Caregiver Support Month • Council meets bi-monthly with top management • Strategic planning for the future – date to be determined. • Functional Statement/competencies review for RN/CM and CSC’s.

14. Questions?